HIE Reduces Medical Imaging Redundancies 25%, Study Says

A health information exchange in New York State is helping several dozen healthcare providers coordinate care and reduce costs, researchers say.

Health insurance exchanges are capable of reducing redundancies in medical imaging, which contributes significantly to care coordination and cost-efficiency gains for healthcare providers, research conducted in New York state indicates.

A study, recently published in the American Journal of Managed Care, focuses on the Rochester Regional Health Information Organization, a nonprofit HIE launched in 2006. The study found that dozens of healthcare providers shared medical imaging data through the Rochester HIE, reducing the odds of redundant medical imaging by 25%.

"A technology-driven improvement in care that represents both higher quality and potentially lower costs," is suggested by the findings, researchers conclude.

Several dozen healthcare providers, including hospitals, urgent care clinics, and physician practices, are tapping RRHIO data in the HIE's 13-county service area. RRHIO's executive director, Ted Kremer, MPH, says building partnerships with healthcare providers and key community stakeholders has been an essential element of success for the HIE.

"We did outreach with the imaging providers early on and showed them how providing data to our exchange would in turn make it easier to access prior images done elsewhere. We also had strong support from our county public health department charged with managing [tuberculosis] patients, who were moving between treating institutions and care providers," Kremer says.

Developing the RRHIO has been as much about organizing physicians as organizing data. "Where there were early and enthusiastic adopters, we sought to share their positive experiences with other care providers and with community leaders seeking to realize a more efficient healthcare system."

Those community leaders, Kremer says, "were very helpful in overcoming some of the institutional reluctance there may have been to adopting this multi-stakeholder approach. We also shared with clinical leaders who did not initially see the value of radiology exchange services how various specialty groups and care settings were increasing the use of our services and seeing the value of these services."

Mark Halladay, IT services director for UR Medicine-Thompson Health, says the Canandaigua, NY-based organization and other healthcare providers across the region have benefited from participating in RRHIO. "We have been able to direct more health information through the RRHIO as a common source for other healthcare providers, which has made the information more accessible at lower cost. Also, the RRHIO has increasingly become an additional source of healthcare information for us," he said.

The HIE is user-friendly from the provider perspective. "The RRHIO has provided the appropriate information infrastructure for providing viewing access by providers as well as for incorporating the information into provider electronic medical records."

Catherine Shannon, director of practice management for UR Medicine-Thompson Health, says participating in RRHIO generates significant benefits for physicians. By having results returned electronically, "providers are able to get results much faster than in the paper world… we can also easily and instantaneously graph results over time, a process that would have taken a lot of manual work previously. This helps the providers understand the patient’s progress over time," she says.

Patients also played a pivotal role in RRHIO's development, Kremer said. "Perhaps most importantly, we were fortunate that patients wanted to share their stories, in which image exchange service both improved their care and reduced their challenges of carting imaging studies from place to place."

Rochester RHIO has boosted care coordination and generated cost-efficiency gains in areas beyond medical imaging, Kremer says. "We also include Emergency Medical Services-based data and eldercare social services information to assist with care coordination and care event notification services. Our larger health information exchange services have also shown a reduction in both 30-day [hospital] readmissions as well as emergency department-based hospital admission rates."

'Information Needs to be Accessed and Used'

The lead author of the AJMC study, Joshua Vest, PhD, MPH, an assistant professor at Weill Cornell Medical College in New York City, says the technical approach of Rochester RHIO is relatively simple.

"[It] facilitates health information exchange services for providers in the community. Health information exchange is a fairly straightforward concept: make it easier for physicians, nurses, and other healthcare professionals to get patient information," he says.

"So much patient information is spread across different practices, hospitals and health systems, that getting a comprehensive picture of the patient is difficult. Health information exchange enables providers easier access to that information. We found that when a patient's information was accessed through the health information exchange, it was less likely that the patient would have a repeat imaging exam."

Although Vest and his colleagues did not attach a dollar figure to the medical-imaging cost savings realized by RRHIO's participating providers, the researchers were able to document impressive reductions of redundant imaging in two of the top diagnostic testing categories: radiography and ultrasound. Among physicians accessing Rochester RHIO data, the odds of a repeat ultrasound were reduced 44% and the odds of a repeat radiograph were cut 21%.

For Medicare Part B payments alone from 2003 to 2013, annual spending on ultrasound testing in inpatient settings ranged from about $320 million to about $290 million, according to the Harvey L. Neiman Health Policy Institute.

Vest says HIEs have tremendous potential to increase the quality and cost-effectiveness of healthcare services. "A key factor for success is integrating the technology into clinical workflow. Several studies, ours included, have associated health information exchange usage with reductions in admission via the emergency department, reduced readmissions, and reduced imaging. The key, however, is that the information needs to be accessed and used."

The study notes there have been fewer than 40 studies on the impact HIEs have on healthcare-service utilization. The leader of the Indiana Health Insurance Exchange, one of the oldest HIEs in the country, says more research is needed.

"In the past, some of the HIE services offered in Indiana have been studied and shown both quality improvements and/or economic benefits. However, I wish there were a lot more studies, as quantitative evidence is valuable in a number of ways," IHIE interim President and CEO John Kansky said this week.