Do Health Information Exchanges Deter Repetition of Medical Services?

Eftekhari, Saeede; Yaraghi, Niam; Singh, Ranjit; Gopal, Ram D.; Ramesh, Ram

doi:10.2139/ssrn.2971503

Cited by 6 publications

(7 citation statements)

References 57 publications

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“…Prior work has demonstrated a decrease in duplication in diagnostic studies with HIE, [41][42][43][44][45][46] but these studies focused on provider-provider exchange. Veteran patients who are downloading and sharing data with their non-VA providers have essentially developed a workaround (e.g., using patientmediated medical records) in which they share information between their VA and non-VA providers because it is needed due to systems structures, including the challenges of non-VA physician access to the VA EHR.…”

Section: Discussionmentioning

confidence: 99%

“…While duplication of these services may be driven by provider preferences, patient requests, and other factors, 1 repeated laboratories and images are often due to lack of sharing of patient information across providers and systems of care. 2 Duplication of laboratory testing has been estimated at 32%, with 20% of duplicated tests not clinically indicated, meaning that the test would not have been ordered if prior results were known to the provider. 3 While there are limited studies on duplicate testing in Veterans Affairs (VA) facilities, Maciejewski et al 4 examined overtesting and undertesting among Veterans who used only VA services and those who were ''dual users'' (i.e., Veterans who are eligible for and receive care through VA and in non-VA care settings).…”

Section: Introductionmentioning

confidence: 99%

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Impact of Patient Portal Use on Duplicate Laboratory Tests in Diabetes Management

Wakefield

Turvey

Hogan

et al. 2020

Telemedicine and e-Health

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Background: Patients seek care across multiple health care settings. One coordination issue is the unnecessary duplication of laboratory across different health care settings. This analysis examined the association between patient portal use and duplication of laboratory testing among Veterans who are dual users of Veterans Affairs (VA) and non-VA providers. Materials and Methods: A national sample of Veterans who were newly authenticated users of the portal during fiscal year (FY) 2013 who used Blue Button at least once were compared with a random sample of Veterans who were not registered to use the portal. From these two groups, Veterans who were also Medicare-eligible users in FY2014 were identified. Duplicate testing was defined as receipt of more than five HbA1c (hemoglobin A1c) in 1 year. Results: Use of the Blue Button decreased the odds of duplicate HbA1c testing in VA and Medicare-covered facilities across three comparisons: (1) overall between users and nonusers: portal users were less likely to have duplicate testing; (2) prepost comparison: there was a trend toward lower duplicate testing in both groups across time; and (3) pre-post comparisons accounting for use of the portal: the trend toward lower duplicate testing was greater in Blue Button users. Conclusion: Duplicate HbA1c testing was significantly lower in dual users of VA and Medicare services who used the Blue Button feature of their VA patient portal. Non-VA providers encounter barriers to access of complete information about Veterans who also use VA health care. Provider endorsement of consumer-mediated health information exchange could help further this model of sharing information.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Impact of Patient Portal Use on Duplicate Laboratory Tests in Diabetes Management

Wakefield

Turvey

Hogan

et al. 2020

Telemedicine and e-Health

View full text Add to dashboard Cite

show abstract

“…We believe that effective health information exchange can avoid repeated examinations and medications [18,19] and reduce unnecessary medical expenses [6,20]. Thus, the CMS of the United States requires health care providers who accept government subsidies to achieve the criteria of meaningful use [9].…”

Section: Discussionmentioning

confidence: 99%

An Assessment of the Interoperability of Electronic Health Record Exchanges Among Hospitals and Clinics in Taiwan

et al. 2019

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Background The rapid aging of the Taiwanese population in recent years has led to high medical needs for the elderly and increasing medical costs. Integrating patient information through electronic health records (EHRs) to reduce unnecessary medications and tests and enhance the quality of care has currently become an important issue. Although electronic data interchanges among hospitals and clinics have been implemented for many years in Taiwan, the interoperability of EHRs has not adequately been assessed. Objective The study aimed to analyze the efficiency of data exchanges and provide suggestions for future improvements. Methods We obtained 30 months of uploaded and downloaded data of EHRs among hospitals and clinics. The research objects of this study comprised 19 medical centers, 57 regional hospitals, 95 district hospitals, and 5520 clinics. We examined 4 exchange EHR forms: laboratory test reports, medical images, discharge summaries, and outpatient medical records. We used MySQL (Oracle Corporation) software (to save our data) and phpMyAdmin, which is a Personal Home Page program, to manage the database and then analyzed the data using SPSS 19.0 statistical software. Results The quarterly mean uploaded volume of EHRs among hospitals was 52,790,721 (SD 580,643). The quarterly mean downloaded volume of EHRs among hospitals and clinics was 650,323 (SD 215,099). The ratio of uploaded to downloaded EHRs was about 81:1. The total volume of EHRs was mainly downloaded by medical centers and clinics, which accounted for 53.82% (mean 318,717.80) and 45.41% (mean 269,082.10), respectively, and the statistical test was significant among different hospital accreditation levels ( F 2 =7.63; P <.001). A comparison of EHR download volumes among the 6 National Health Insurance (NHI) branches showed that the central NHI branch downloaded 11,366,431 records (21.53%), which was the highest, and the eastern branch downloaded 1,615,391 records (3.06%), which was the lowest. The statistical test among the 6 NHI branches was significant ( F 5 =8.82; P <.001). The download volumes of laboratory tests reports and outpatient medical records were 26,980,425 (50.3%) and 21,747,588 records (40.9%), respectively, and were much higher than medical images and discharge summaries. The statistical test was also significant ( F =17.72; P <.001). Finally, the download time showed that the average for x-rays was 32.05 seconds, which was the longest, and was 9.92 seconds for electrocardiogram, which was the shortest, but there was no statistically significant difference among download times for various medical images. Conclusions After years of operation, the Electronic Medical Record Exchange Center has achieved the initia...

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“…The extent to which HIE impacts the delivery of patient care has been addressed in prior studies. More generally, the timely sharing of patient clinical information has been shown to improve the accuracy of diagnoses, reduce the number of duplicative tests, prevent hospital readmissions, and prevent medication errors (Frisse et al 2011 ; Furukawa et al 2013 ; Kaelber and Bates 2007 ; Yaraghi 2015 ; Eftekhari et al 2017 ). For HIE specifically, usage has been associated with decreased odds of diagnostic neuroimaging and increased adherence with evidence-based guidelines (Bailey et al 2013 ).…”

Section: Introductionmentioning

confidence: 99%

Impact of Provider Prior Use of HIE on System Complexity, Performance, Patient Care, Quality and System Concerns

et al. 2020

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To date, most HIE studies have investigated user perceptions of value prior to use. Few studies have assessed factors associated with the value of HIE through its actual use. This study investigates provider perceptions on HIE comparing those who had prior experience vs those who had no experience with it. In so doing, we identify six constructs: prior use, system complexity, system concerns, public/population health, care delivery, and provider performance. This study uses a mixed methods approach to data collection. From 15 interviews of medical community leaders, a survey was constructed and administered to 263 clinicians. Descriptive statistics and analysis of variance was used, along with Tukey HSD tests for multiple comparisons. Results indicated providers whom previously used HIE had more positive perceptions about its benefits in terms of system complexity ( p = .001), care delivery ( p = .000), population health ( p = .003), and provider performance ( p = .005); women providers were more positive in terms of system concerns ( p = .000); patient care ( p = .031), and population health ( p = .009); providers age 44–55 were more positive than older and younger groups in terms of patient care ( p = .032), population health ( p = .021), and provider performance ( p = .014); while differences also existed across professional license groups (physician, nurse, other license, admin (no license)) for all five constructs ( p < .05); and type of organization setting (hospital, ambulatory clinic, medical office, other) for three constructs including system concerns ( p = .017), population health ( p = .018), and provider performance (p = .018). There were no statistically significant differences found between groups based on a provider’s role in an organization (patient care, administration, teaching/research, other). Different provider perspectives about the value derived from HIE use exist depending on prior experience with HIE, age, gender, license (physician, nurse, other license, admin (no license)), and type of organization setting (hospital, ambulatory clinic, medical office, other). This study draws from the theory of planned behavior to understand factors related to physicians’ perceptions about HIE value, serving as a departure point for more detailed investigations of provider perceptions and behavior in regard to future HIE use and promoting interoperability.

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Do Health Information Exchanges Deter Repetition of Medical Services?

Cited by 6 publications

References 57 publications

Impact of Patient Portal Use on Duplicate Laboratory Tests in Diabetes Management

Impact of Patient Portal Use on Duplicate Laboratory Tests in Diabetes Management

An Assessment of the Interoperability of Electronic Health Record Exchanges Among Hospitals and Clinics in Taiwan

Impact of Provider Prior Use of HIE on System Complexity, Performance, Patient Care, Quality and System Concerns

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