Yuan Yingzhe, Price Megan, Schmidt David F, Ward Merry, Nebeker Jonathan, Pizer Steven
Department of Health Law, Policy & Management, School of Public Health, Boston University, Boston, MA, United States.
Partnered Evidence-Based Policy Resource Center, Boston Veterans Affairs Healthcare System, Boston, MA, United States.
JMIR Med Inform. 2022 May 20;10(5):e32168. doi: 10.2196/32168.
Health information exchange and multiplatform health record viewers support more informed medical decisions, improve quality of care, and reduce the risk of adverse outcomes due to fragmentation and discontinuity in care during transition of care. An example of a multiplatform health record viewer is the VA/DoD Joint Longitudinal Viewer (JLV), which supports the Department of Veterans Affairs (VA) and Department of Defense (DoD) health care providers with read-only access to patient medical records integrated from multiple sources. JLV is intended to support more informed medical decisions such as reducing duplicate medical imaging when previous image study results may meet current clinical needs.
We estimated the impact of provider usage of JLV on duplicate imaging for service members transitioning from the DoD to the VA health care system.
We conducted a retrospective cross-sectional study in fiscal year 2018 to examine the relationship between providers' use of JLV and the likelihood of ordering duplicate images. Our sample included recently separated service members who had a VA primary care visit in fiscal year 2018 within 90 days of a DoD imaging study. Patients who received at least one imaging study at VA within 90 days of a DoD imaging study of the same imaging mode and on the same body part are considered to have received potentially duplicate imaging studies. We use a logistic regression model with "JLV provider" (providers with 1 or more JLV audits in the prior 6 months) as the independent variable to estimate the relationship between JLV use and ordering of duplicate images. Control variables included provider image ordering rates in the prior 6 months, provider type, patient demographics (age, race, gender), and clinical characteristics (Elixhauser comorbidity score).
Providers known to utilize JLV in the prior 6 months order fewer duplicate images relative to providers not utilizing JLV for similar visits over time (odds ratio 0.44, 95% CI 0.24-0.78; P=.005). This effect is robust across multiple specifications of linear and logistic regression models. The provider's practice pattern of ordering image studies and the patient's health status are powerful confounders.
This study provides evidence that adoption of a longitudinal viewer of health records from multiple electronic health record systems is associated with a reduced likelihood of ordering duplicate images. Investments in health information exchange systems may be effective ways to improve the quality of care and reduce adverse outcomes for patients experiencing fragmentation and discontinuity of care.
健康信息交换和多平台健康记录查看器有助于做出更明智的医疗决策，提高护理质量，并降低因护理过渡期间护理的碎片化和不连续性而导致不良后果的风险。多平台健康记录查看器的一个例子是退伍军人事务部/国防部联合纵向查看器（JLV），它为退伍军人事务部（VA）和国防部（DoD）的医疗保健提供者提供只读访问权限，以访问从多个来源整合的患者医疗记录。JLV旨在支持做出更明智的医疗决策，例如当先前的影像研究结果可能满足当前临床需求时，减少重复的医学影像检查。
我们估计了医疗服务提供者使用JLV对从国防部医疗保健系统过渡到退伍军人事务部医疗保健系统的军人重复成像的影响。
我们在2018财年进行了一项回顾性横断面研究，以检查医疗服务提供者对JLV的使用与订购重复影像的可能性之间的关系。我们的样本包括在2018财年国防部进行影像检查后90天内接受退伍军人事务部初级保健就诊的最近退役军人。在国防部对同一影像模式和同一身体部位进行影像检查后90天内，在退伍军人事务部接受至少一次影像检查的患者被视为接受了潜在的重复影像检查。我们使用一个逻辑回归模型，将“JLV医疗服务提供者”（在过去6个月内有1次或更多次JLV审计的医疗服务提供者）作为自变量，以估计JLV使用与重复影像订购之间的关系。控制变量包括过去6个月内医疗服务提供者的影像订购率、医疗服务提供者类型、患者人口统计学特征（年龄、种族、性别）和临床特征（埃利克斯豪泽合并症评分）。
与随着时间推移在类似就诊中未使用JLV的医疗服务提供者相比，已知在过去6个月内使用JLV的医疗服务提供者订购的重复影像较少（优势比为0.44，95%置信区间为0.24 - 0.78；P = 0.005）。在多个线性和逻辑回归模型规范中，这种效应都很稳健。医疗服务提供者订购影像检查的实践模式和患者的健康状况是强大的混杂因素。
本研究提供了证据，表明采用来自多个电子健康记录系统的健康记录纵向查看器与订购重复影像的可能性降低相关。对健康信息交换系统的投资可能是提高护理质量和减少经历护理碎片化和不连续性的患者不良后果的有效方法。
