Two EDs using HIE platforms slash imaging orders: small but careful study

The Office of the National Coordinator for Health IT (ONC) has awarded more than half a billion dollars to fund the formation and growth of health information exchanges ( HIEs). Has the return been worth the investment? One researcher has looked into that question, found a qualified Yes—and pointed to decreased radiology utilization as a prime piece of supporting evidence.

Niam Yaraghi, a fellow of the Brookings Institution think tank, reviewed lab and radiology order logs at two emergency departments in western New York. At one he studied 848 logs and found that the facility cut imaging orders a bracing 47 percent when clinicians accessed patient information via HIE. At another he assessed 721 order logs and saw a more modest yet still substantial HIE-associated reduction in imaging utilization, 26 percent.

The treatment group consisted of patients for whom sufficient medical data existed and whose records were accessed via the HIE—or, in this case, the RHIO, for regional health information organization—in every ED encounter in the study. Trained liasisons assisted with the HIE queries. Patients whose records were never queried in the HIE during the study period comprised the control group. 

In a 13-page paper detailing the work, Yaraghi cited a similar study he conducted in a different ED setting that has been accepted for publication in the Journal of the American Medical Informatics Association . In that trial, he wrote in the Brookings paper, the patients in the control and treatment groups were treated by different physicians. “However, in this [new] study the patients in the control group are treated by the same ED clinicians who treated patients in the treatment group. This feature further ensures that physician-level characteristics do not drive the differences in the outcome measures.”

What portion of the utilization drops owed to elimination of redundant exams—one of ONC’s key HIE objectives—versus more judicious front-end clinical decisionmaking by referrers and/or radiologists, or a mix of these and other factors? That question may have to wait until another research project.

“[T]he potential benefits of increased access to HIE platforms call for more detailed studies on efficient strategies and workflow designs which enable ED clinicians to access HIE in smoother and user friendlier manners,” wrote Yaraghi.

In his concluding analysis, Yaraghi stressed the importance of designing ED workflows that incorporate HIE access as a standard operating practice. Given widespread adoption at that level, he wrote, “HIE platforms have the potential to leverage the national investments on interoperability and radically improve the efficiency of healthcare services.”

Brookings has posted Yaraghi’s full research paper. It includes an appendix on patient outcomes associated with HIEs as evaluated in previous studies.