Abstract
Background/Aims HIEs are secure computer networks that allow sharing of patients’ health records across health care organizations in a standard format to provide more comprehensive information to providers at the point of care. Potential HIE benefits include improved quality (better care coordination, decreased errors) and reduced costs (reduced redundant lab and radiology orders). The New Mexico Health Information Collaborative (NMHIC), the State’s HIE, is implementing pilot clinical use sites in Albuquerque area Emergency Departments (EDs). Here we present the approach evaluating our pilots HIE implementation in the ED setting for its effect on the rate of redundant lab and radiology orders.
Methods This is an analysis of the rates of redundant lab and radiology orders before and after installation of an HIE access portal in 2 New Mexico emergency departments. Redundant tests are subsequent tests that provide no more clinically useful data that what is available from the preexisting test. Rates are measured by identifying all ED procedures P and their associated primary diagnosis D. For each first PD pair in the baseline year, count subsequent matching PD pairs as potential duplicates. Filter potential duplicates by evaluating days between pairs and excluding those within clinical guidelines (e.g., >1/month for fractures).
Rates are Poisson Sum redundant test type ‘PD’/Sum initial test type ‘PD’ per-member-month.
Results For baseline period 1/2009 – 12/2009, we identified 1,464 PD pairs where the procedure was chest x-ray, of which 548 (37%) were potentially redundant, for a rate of 3.1% (2.2–4.2%) per 100,000 member months. We identified 415 PD pairs where the procedure was CT scan, of which 132 (32%)were potentially redundant, for a rate of 7.4% (5.0–10.6%) per 100,000 member months. Rates will be calculated for a similar period following the HIE implementation and compared to baseline rates to assess the impact.
Discussion The HIE represents a new tool that can potentially reduce the rates of redundant testing in the ED setting. The process of defining redundant tests is a critical component of this kind of analysis. More work is needed in this area to define, standardize, and validate the “rules” for categorizing tests as redundant.
