Too Many Docs Served by HIE Order Duplicate CT Scans

An 18-month study at HEALTHeLINK, the health information exchange serving western New York, finds more than 2,700 CT scans--10 percent of the total such scans of three parts of the body ordered during the period--were potentially unnecessary duplicate scans.

Further, 90 percent of the unnecessary scans were ordered by physicians who never or rarely used the HIE to query for previous scans for the patient. The study covered scans ordered for the same patient covering the head and neck, chest and abdomen.

More than 70 percent of the duplicate scans were ordered by physicians who did not query for past scans through HEALTHeLINK, and 95 percent of duplicates came from hospitals, including 44 percent from emergency departments. Only 1.1 percent of orders for duplicate scans came from physicians who are frequent users of the HIE, suggesting they are querying for earlier scans before ordering.

Three major insurers in the region, BlueCross BlueShield of Western New York, Independent Health and Univera Healthcare, supplied CT scan claims data from July 2011 through December 2012. “The goal of this data analysis was to measure the impact of the use of HEALTHeLINK’s patient query function which allows participating providers to securely and electronically access current health information about the patients they are treating through the HIE,” according to study results. CT scans were selected because of their increasing use and because of the risk of patients being exposed to unnecessary radiation from the higher-dose procedure.

(See also: WEDI's 10 Recommendations for Next-Generation HIE)

The study did not count many scans because of various reasons why a duplicate test may have been necessary. For instance, a physician ordering a second scan on a patient during a six-month period would have results from the first scan and assumingly have an appropriate reason for needing another one.

The high rate of duplicate scans in hospitals and particularly emergency department is now the focus of a new HEALTHeLINK study, says Daniel Porreca, executive director. The HIE has to figure out how to make its services more usable in hospitals, he adds.

Many hospitals have awareness of HEALTHeLINK’s services, “but it’s up to us to make it more usable in their environments,” Porreca acknowledges. A pilot project is underway at one local ED to quantify the value of using HIE and how best to make the data available. “We need to put hospitals in position to best utilize HIE,” he says.

A white paper on results of the study is available here.

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