Abstract
BACKGROUND/AIMS: More than 40% of outpatient visits involve a transition in care. Effectively coordinating care across providers is critical to reducing healthcare costs and improving patient safety and quality of care. Electronic health information exchange (eHIE) facilitates coordination of care by enabling information transfer across providers and medical clinics. By increasing care coordination, eHIE is expected to reduce healthcare costs resulting from redundant lab tests and radiology studies. In this study, we examine the economic consequences of eHIE in the context of x-ray imaging for bone fractures. METHODS: We have previously demonstrated that eHIE is associated with a significant reduction in follow-up x-ray imaging for patients with bone fractures of the extremities. This retrospective cohort study of Kaiser Permanente Mid-Atlantic States (KPMAS) members 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. Here, we use the Medicare fee schedule to estimate costs for all imaging events, including x-rays, CT scans and MRIs, during the two month period following the initial fracture diagnosis. We estimate total cost by identifying all relevant radiology procedures during the two months following the index event and assigning costs based on published estimates for each procedure. RESULTS: The study included 5680 patients from KPMAS with bone fractures diagnoses. 38% of patients were initially seen in the ED, while 62% of patients were seen in outpatient care. The median cost of imaging procedures in the month after diagnosis was $30.60. Patients who received diagnosis and follow-up care at facilities that did not have active eHIE cost the healthcare system 1.7 times as much as patients who received diagnosis and follow-up care at institutions that electronically shared radiology data between facilities and providers. CONCLUSIONS: eHIE reduces healthcare costs related to duplication of diagnostic tests, specifically imaging studies. Next steps will be to evaluate the impact of different eHIE access methods on its effectiveness.