| Abstract: | Background/Aims Unnecessary duplication of diagnostic procedures such as x-rays increases healthcare costs and jeopardizes patient safety. Electronic health records (EHRs) have the potential to reduce unnecessary duplication of diagnostic studies by improving timely access to the original test results. However, when follow-up care occurs in a different institutional setting, providers may not have access to the same EHR. In such cases, electronic health information exchange (HIE) could improve the quality and timeliness of information available to the follow-up provider, thereby reducing the need to order duplicative diagnostic tests. Our primary goal in this work was to determine if members with diagnoses of bone fractures were less likely to receive follow-up x-rays when findings from the initial diagnostic imaging study were available in the electronic health record. Our secondary goal was to estimate the economic costs and patient safety repercussions of duplicate imaging studies. Methods This retrospective cohort study of Kaiser Permanent members in the Mid-Atlantic States (KPMAS) compared the rate of duplicate x-rays in patients with a diagnosis of bone fractures from the Emergency Department (ED) or from outpatient care between 2006 and 2010. We used the Medicare fee schedule to estimate costs for the total episode of care. We estimated radiation exposure by identifying all relevant radiology procedures during the two months following the index event and assigning radiation levels based on published estimates for each procedure. Results The study included approximately 50,000 patients from KPMAS with a bone fractures diagnosis. 20% of patients were initially seen in the ED, while 80% of patients were seen in outpatient care. Patients initially seen at a KPMAS outpatient facility were more likely than patients initially seen in the ED to have x-ray findings recorded in the KPMAS EHR prior to their follow-up visit. These patients were also significantly less likely to have duplicated (same or similar) radiology procedures ordered at follow-up visits. Discussion When the findings from preliminary imaging studies are available in the EHR, providers are less likely to order similar x-rays at follow-up visits. This reduction in duplicate radiology procedures significantly reduces costs and increases patient safety. |
