Study: Access to lab data in HIE can affect testing volume
Having access to patients' laboratory test results influences the decision-making process regarding the ordering of further tests, which supports the predictions of financial savings made in the health information exchange (HIE) cost-benefit models, according to an article published in the March 26 edition of Archives of Internal Medicine.
Esteban Hebel, MD, from Harvard Medical School and the clinical informatics research and development department, Partners Healthcare, Boston, and colleagues conducted a retrospective study to investigate whether the availability of laboratory test results from a nonencounter hospital reduced the number of subsequent laboratory tests at the encounter hospital.
A single new consultation encounter—the index encounter—served as a unit of analysis. The number of laboratory tests performed until the end of the day of the index encounter at the same institution as the encounter (post-encounter, on-site tests) served as the primary outcome variable.
The researchers identified 122,771 patients between Jan. 1, 1999, and Dec. 31, 2004, yet excluded 5,146 patients who were admitted to the hospital 10 days or fewer after the index encounter and 19 patients who had tests in both institutions during the week prior to the encounter. The remaining 117,606 patients were included in the study.
Of the 346 study encounters with recent off-site tests, 44 took place prior to HIE rollout. Among the 117,260 encounters without preceding off-site tests, 21,968 took place prior to HIE rollout. Patients with recent off-site tests had a mean of 22.07 tests prior to the index encounter. Patients without recent off-site tests had a mean of 1.62 tests prior to the index encounter.
“In univariate analysis, the number of laboratory tests performed after encounters that had recent off-site laboratory tests decreased by 49 percent after introduction of the HIE,” the authors found. “In multivariable analysis … the number of tests after the encounters with prior off-site tests decreased by 52.6 percent after the EMR integration.”
In addition, the number of tests decreased by 0.84 percent for every $10,000 increase in the patient's median household income, according to the authors. It was also 9.06 percent lower for the patients on Medicaid compared with patients with private health insurance.
“In this large retrospective study we have demonstrated that the introduction of an internal HIE was associated with a significant decrease in the number of laboratory tests ordered for patients new to the provider when recent laboratory results were available from another institution,” the authors concluded. “Importantly, our results indicate that the reduction in laboratory tests may be as high as 50 percent. This could potentially translate into significant savings in settings where patients frequently receive care at multiple institutions.”
Esteban Hebel, MD, from Harvard Medical School and the clinical informatics research and development department, Partners Healthcare, Boston, and colleagues conducted a retrospective study to investigate whether the availability of laboratory test results from a nonencounter hospital reduced the number of subsequent laboratory tests at the encounter hospital.
A single new consultation encounter—the index encounter—served as a unit of analysis. The number of laboratory tests performed until the end of the day of the index encounter at the same institution as the encounter (post-encounter, on-site tests) served as the primary outcome variable.
The researchers identified 122,771 patients between Jan. 1, 1999, and Dec. 31, 2004, yet excluded 5,146 patients who were admitted to the hospital 10 days or fewer after the index encounter and 19 patients who had tests in both institutions during the week prior to the encounter. The remaining 117,606 patients were included in the study.
Of the 346 study encounters with recent off-site tests, 44 took place prior to HIE rollout. Among the 117,260 encounters without preceding off-site tests, 21,968 took place prior to HIE rollout. Patients with recent off-site tests had a mean of 22.07 tests prior to the index encounter. Patients without recent off-site tests had a mean of 1.62 tests prior to the index encounter.
“In univariate analysis, the number of laboratory tests performed after encounters that had recent off-site laboratory tests decreased by 49 percent after introduction of the HIE,” the authors found. “In multivariable analysis … the number of tests after the encounters with prior off-site tests decreased by 52.6 percent after the EMR integration.”
In addition, the number of tests decreased by 0.84 percent for every $10,000 increase in the patient's median household income, according to the authors. It was also 9.06 percent lower for the patients on Medicaid compared with patients with private health insurance.
“In this large retrospective study we have demonstrated that the introduction of an internal HIE was associated with a significant decrease in the number of laboratory tests ordered for patients new to the provider when recent laboratory results were available from another institution,” the authors concluded. “Importantly, our results indicate that the reduction in laboratory tests may be as high as 50 percent. This could potentially translate into significant savings in settings where patients frequently receive care at multiple institutions.”