Health Information Exchange Reduces Unnecessary Imaging, Lowers Costs

Access to an electronic health information exchange (HIE) system can reduce costs associated with unnecessary repeated imaging tests, claims a new study. 

Imaging procedures such as x-rays or ultrasounds comprise a large portion of health care spending, with an estimated $10 billion being spent annually by Medicare. Repeat or redundant imaging tests are a significant contributor to this high cost.

Researchers from Weil Cornell Medicine (New York, NY) conducted a study to determine whether implementing an HIE system could result in cost savings attributable to fewer repeat imaging tests. 

To test their hypothesis, the HITEC Investigators, led by Hye-Young Jung, PhD, looked at data from 12,620 patients who received imaging tests between 2009 and 2010 and were enrolled in the two largest commercial health plans in a 13-county region of western New York State served by the Rochester Regional Health Information Organization, a nonprofit company. 

To calculate the estimated health savings, researchers broke their sample into two primary groups: those whose health care providers had access to an HIE system (3843 patients), and those whose health care providers did not (8777 patients). All patients received an imaging test and returned to their health care provider within 90 days. If patients did not receive repeat imaging tests when a provider had access to a HIE system, they were counted toward cost savings. 

The most common basic imaging procedures used in the samples were radiography (45.6%), mammography (9.5%), and ultrasound (15.7%). Advanced tests, such as computed tomography (CT) (14.8%) and magnetic resonance imaging (MRI) (7.9%), were also used. 

In total, 804 patients (6.4%) received repeat imaging tests. On average, the repeated imaging tests were conducted 40.8 days after the initial imaging procedure. Among patients for whom HIE systems were accessed, 213 patients (5.5%) received a second test within 90 days. In contrast, among patients for whom HIE systems were not accessed, a significantly greater proportion of patients (591; 6.73%) received a second test within 90 days. Overall, HIE use produced a 19% reduction in the odds of an imaging procedure being repeated within 90 days.

After further analysis, researchers also estimated that the use of a HIE system helped to avoid 47 cases of unneeded or repeat imaging procedures, equating to $8115 in savings. Extrapolated, this would translate to about $32,460 in cost savings per year, or $2.57 per patient. 

Basic imaging tests (radiography, ultrasound, and mammography) accounted for 85.1% of all avoided cases of repeat imaging and 46.7% of estimated cost savings. However, despite accounting for only 12.8% of avoided tests, advanced techniques such as CT or MRI scans were associated with more than half of estimated cost savings (50.1%).

The authors concluded that their results demonstrate the value of HIE systems for lowering costs through a reduction of unneeded imaging procedures. 

The study was limited by an inability to account for increases in costs associated with avoidable alternative imaging procedures and a lack of insight regarding clinical decision-making. Additionally, more research is necessary to determine whether more detailed HIE systems that are widely implemented could generate greater cost savings. 

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Jung HY, Vest JR, Unruh MA, Kern LM, Kaushal R, HITEC Investigators. Use of health information exchange and repeat imaging costs. J Am Coll Radiol. 2015;(12 Pt B):1364-1370.