Commitment to HIE implementation can result in less exams, more savings

The implementation of health information exchange (HIE) platforms can lead to decreases in the number of radiology exams completed by an emergency department (ED) and significant savings, according to research by Niam Yaraghi, Brookings Institution fellow.

“Electronic exchange of medical data is one of many different potential IT solutions for improving efficiency in the health care system; it facilitates the timely access to patients’ medical records, which is crucial for physicians to make better decisions and avoid many redundant and often harmful medical procedures,” Yaraghi wrote. “Fewer redundancies and better medical decisions will naturally lead to much needed savings in the health care system.”

Yaraghi looked at how access to a regional health information organization (RHIO) – a type of HIE platform where medical data is both uploaded and downloaded – affected two different New York EDs in 2014. The EDs did not want to be identified, but both were in urban areas of Western New York.

At each ED, Yaraghi studied both a treatment group and a control group, each made up of 300 to 500 patients. For the treatment group, sufficient medical data was available for each patient and the RHIO was queried in 100% of patient encounters. (Other studies, he pointed out, have shown the actual average to be closer to 10% of patient encounters.) The control group was made up of the patients whose care did not involve the HIE at all.

Overall, the HIE platform led to 26% less radiology exams in the first ED he studied and 47% less in the second ED. Yaraghi wrote that these numbers show the United States may be close to getting its money’s worth for the years of continued investment in healthcare.

“After more than a decade of concerted national efforts, we are now on the verge of realizing the returns on our investments on health IT,” Yaraghi wrote. “HIE platforms have the potential to leverage the national investments on interoperability and radically improve the efficiency of health care services.”

It was crucial for the study that the RHIO was used in 100% of treatment group patient encounters. Trained liaisons had to be brought in to the ED to handle the high number of RHIO queries, which adds cost, but Yaraghi wrote that the positive results indicate it was an effective solution, and there is still room to improve on it.

“The results of this study enables other ED settings to evaluate the benefits of increasing their HIE querying rate against its potential costs,” Yaraghi wrote. “Moreover, the potential benefits of increased access to HIE platforms calls for more detailed studies on efficient strategies and workflow designs which enable ED clinicians to access HIE in smoother and user friendlier manners.”