ER patients benefit when hospitals share records online

If adopted nationwide, health information exchanges could reduce annual health care costs by as much as $19 million by eliminating repeat imaging tests ordered by emergency rooms at different hospitals. (Credit: "hospital patient records" via Shutterstock)

Online systems that allow hospitals to share medical information cut unnecessary care and costs, research shows.

A new study finds that fewer emergency patients got repeated medical scans when they went to a hospital that takes part in a health information exchange, or HIE. And although the study focuses specifically on scans done on patients who went to two different emergency departments in a 30-day period, the findings serve as a good test case for the effectiveness of HIEs, researchers say.


The study is one of the first to show with hard data that HIEs may deliver the increased efficiency they promise.

The researchers chose to examine emergency care because emergency department teams need information quickly in order to diagnose and treat a patient, says senior author Keith Kocher, assistant professor of emergency medicine at the University of Michigan.

The ability to log into a computer and pull up that patient’s previous records from other hospitals through an HIE—instead of ordering duplicate tests or scans—holds great promise, he says. But until now, large-scale studies haven’t been done.

Published online in the journal Medical Care, the findings show that the use of repeat CT scans, chest X-rays, and ultrasound scans was significantly lower when patients had both their emergency visits at two unaffiliated hospitals that took part in an HIE. The data come from two large states that were among the early adopters of HIEs: California and Florida.

Patients were 59 percent less likely to have a redundant CT scan, 44 percent less likely to get a duplicate ultrasound, and 67 percent less likely to have a repeated chest X-ray when both their emergency visits were at hospitals that shared information across an HIE.

Kocher, an assistant professor of emergency medicine, worked with Eric Lammers, who performed the analysis for his doctoral work at the U-M School of Public Health and is now working at Mathematica Policy Research.

“The emergency department is an important test case for whether we would see any impact from HIEs on rates of repeat imaging,” says Eric Lammers, PhD, who performed the analysis for his doctoral work. “The fact that we find that there is a decrease is in and of itself significant.”

Hope and hype

The federal government has incentivized participation in HIEs, offering states grants to form them, and medical providers extra money if they sign on. In Michigan, several HIEs have emerged, and the two largest just announced plans to merge. HIEs are a key extension of the electronic health records that hospitals and practices are also being incentivized to adopt.

“There has been a lot of hope, and some hype, that these systems will enable more efficiency in how care is provided across unaffiliated providers,” says Lammers. The availability of several years of data from various sources in two HIE early-adopter states gave the chance to do the study.

The researchers pooled information from the California and Florida State Emergency Department Databases, for 2007 through 2010, and information on hospital HIE participation and affiliation from the Health Information Management Systems Society annual survey. The state ED databases were compiled as part of the Healthcare Cost and Utilization Project of the federal Agency for Healthcare Research and Quality.

In all, they found that patients in the two states underwent 20,139 repeat CT scans—meaning that 14.7 percent of those who had a CT scan in their first emergency visit had another one at their second emergency visit at another, unaffiliated hospital within a month.

There were also 13,060 repeat ultrasounds, which were ordered for 21 percent of those who had had ultrasounds at their first visit, and 29,703 repeat chest X-rays, ordered for 19.5 percent of those who had an X-ray at their first emergency visit.

$19 million savings

While the researchers couldn’t tell specifically that doctors at the second emergency department had accessed the patient’s records from the first ED, or that it impacted their decision-making if they did, the presence of an HIE at both hospitals means it would have been possible to do so.

They did see that the rates of repeat scanning were higher when an HIE was not present than when one was. They also estimated that if adopted nationwide, HIE might reduce health care costs by $19 million annually for these types of repeat imaging tests in the ED.

“Our data allowed us to study a very specific type of care where HIE was associated with reducing what would potentially be a redundant test by half, which we think is pretty meaningful,” says Kocher. “We can’t say yet how generalizable these results will be to other settings, but these are definitely interesting empirical findings.”

Other types of patient records, such as recent lab test results, can also make a major difference in what an emergency doctor chooses to do when presented with an emergency patient.

Not all states report the relevant data to the HCUP system, Lammers says. More broad reporting could make research on the impact of HIEs easier as the systems become more common nationwide. The data allows researchers to see the activity of individual patients across their different medical encounters, while preserving patient privacy.

Lammers is now part of an effort at Mathematica Policy Research to evaluate the HITECH Act, the federal law that provides for health IT incentives.

Source: University of Michigan