*Mathematica Policy Research †School of Information ‡School of Public Health, Health Management and Policy §Department of Emergency Medicine ∥Center for Healthcare Outcomes and Policy (CHOP), University of Michigan, Ann Arbor, MI.
Med Care. 2014 Mar;52(3):227-34. doi: 10.1097/MLR.0000000000000067.
Broad-based electronic health information exchange (HIE), in which patients' clinical data follow them between care delivery settings, is expected to produce large quality gains and cost savings. Although these benefits are assumed to result from reducing redundant care, there is limited supporting empirical evidence.
To evaluate whether HIE adoption is associated with decreases in repeat imaging in emergency departments (EDs).
DATA SOURCE/STUDY SETTING: ED discharge data from the State Emergency Department Databases for California and Florida for 2007-2010 were merged with Health Information Management Systems Society data that report hospital HIE participation.
Using regression with ED fixed effects and trends, we performed a retrospective analysis of the impact of HIE participation on repeat imaging, comparing 37 EDs that initiated HIE participation during the study period to 410 EDs that did not participate in HIE during the same period. Within 3 common types of imaging tests [computed tomography (CT), ultrasound, and chest x-ray), we defined a repeat image for a given patient as the same study in the same body region performed within 30 days at unaffiliated EDs.
In our sample there were 20,139 repeat CTs (representing 14.7% of those cases with CT in the index visit), 13,060 repeat ultrasounds (20.7% of ultrasound cases), and 29,703 repeat chest x-rays (19.5% of x-ray cases). HIE was associated with reduced probability of repeat ED imaging in all 3 modalities: -8.7 percentage points for CT [95% confidence interval (CI): -14.7, -2.7], -9.1 percentage points for ultrasound (95% CI: -17.2, -1.1), and -13.0 percentage points for chest x-ray (95% CI: -18.3, -7.7), reflecting reductions of 44%-67% relative to sample means.
HIE was associated with reduced repeat imaging in EDs. This study is among the first to find empirical support for this anticipated benefit of HIE.
广泛的电子健康信息交换（HIE），即患者的临床数据在医疗服务提供场所之间跟随患者转移，有望带来巨大的质量提升和成本节约。尽管这些好处被认为是通过减少重复医疗实现的，但实际上仅有有限的经验证据支持。
评估 HIE 采用是否与急诊科（ED）的重复影像检查减少有关。
数据来源/研究环境：将 2007 年至 2010 年加利福尼亚州和佛罗里达州的州急诊数据库与健康信息管理系统协会的数据合并，后者报告了医院 HIE 参与情况。我们使用 ED 固定效应和趋势的回归分析，对 HIE 参与对重复影像的影响进行了回顾性分析，比较了 37 家在研究期间开始 HIE 参与的 ED 和 410 家同期未参与 HIE 的 ED。在 3 种常见影像检查类型[计算机断层扫描（CT）、超声和胸部 X 射线]中，我们将给定患者的重复影像定义为在 30 天内在非附属 ED 进行的同一身体部位的同一研究。
在我们的样本中，有 20139 次重复 CT（占索引就诊中 CT 病例的 14.7%），13060 次重复超声（占超声病例的 20.7%），29703 次重复胸部 X 射线（占 X 射线病例的 19.5%）。HIE 与所有 3 种模式下的 ED 重复影像的可能性降低相关：CT 降低了 8.7 个百分点（95%置信区间：-14.7，-2.7），超声降低了 9.1 个百分点（95%置信区间：-17.2，-1.1），胸部 X 射线降低了 13.0 个百分点（95%置信区间：-18.3，-7.7），反映出相对于样本平均值，降低了 44%-67%。
HIE 与 ED 中的重复影像减少有关。这项研究是首批发现 HIE 预期效益的经验证据的研究之一。
