To scan or not to scan

Image by: Simon James (Flickr / Creative Commons)

As medical imaging is becoming more powerful and readily available, we are seeing increasing utilization across all fields of medicine. These advancements in technology have undoubtedly aided in the advancement of disease diagnosis. However, skyrocketing healthcare costs have caused many to question whether the easy availability of imaging technology has led to redundant use by doctors and patients.

This possible source of inefficiency and waste has caught the attention of the federal government, which is now proposing policies to encourage the use of electronic health information exchange (HIE). The idea behind the implementation of HIE is: If hospitals are able to communicate with each other, sharing test results and imaging scans that have already been conducted, will this reduce health care costs? HIE could allow for patient data exchange across care delivery settings with the ultimate goal of increased savings through improved efficiency.

This study evaluates whether HIE adoption is associated with decreases in repeat imaging in emergency departments. Emergency department discharge data were collected from state databases in both California and Florida between 2007 and 2010 to compare the use of imaging in departments that participated in HIE and those that did not.

Repeat scans were defined as scans done at least twice within 30 days with commonly used imaging technologies, including computed tomography (CT), ultrasound (US), and chest x-ray (CXR). Emergency departments that were part of HIE showed an 8.7% (p=0.005), 9.1% (p=0.027) and 13.0% (p<0.001) reduction, respectively, in repeat imaging. This represents an average 67% relative reduction among all three imaging technologies.

This study showed that patients treated within an emergency department equipped with HIE were less likely to have a repeated, possibly unnecessary scans.

Commentary

This study concludes with an extrapolated national annual cost savings or avoided cost of $19 million if all emergency departments participated in HIE.

Prior studies had produced mixed findings on the actual reduction in repeat use of both imaging scans and laboratory testing with HIE and drew attention to the possible factors that might contribute to the variation in findings. It is important to take into consideration variations in information exchange systems, hospital culture and environment, imaging accessibility, and risk averse behaviors (doctors that order more scans and blood tests to avoid medical liability lawsuits) when considering potential savings.

This study fails to account for appropriateness of repeat imaging and makes little to no mention of the quality of care provided to patients in both the HIE and non-HIE participating facilities. Without any idea of the indication for repeat studies in these patients, this study may have overestimated the actual savings.

Lammers, EJ, et al. Med Care 2014; 52 (3): 227-234.

Listen to Dr. Stinson discuss this article with Dr. Cedric Dark and Dr. Jason Shapiro in our AAEM Emergency Physician Advocates podcast.