This new IT infrastructure sets the stage for sharing patient information as Memphis is doing. And while reducing tests and other procedures might run counter to hospitals’ profit motives, the incentive structure may change under the U.S. health-care reform legislation, which would pay doctors a fixed annual fee to keep patients well, giving them an incentive to reduce duplicate and unnecessary testing.
The Vanderbilt study compared emergency-room outcomes from two groups of patients: one whose clinical background was obtained through electronic records, and another group, with similar conditions or complaints, whose data was not available to doctors.
The study focused on hospital admissions, laboratory testing, head CT scans, body CT scans, ankle and chest X-rays, chest radiographs, and echocardiograms. The clinicians only used the health-exchange information when they felt it was necessary. As things turned out, such checking was done in seven of every 100 patients—but was done at least 20,000 times during the study.
The information-exchange system works like this: unless patients specifically opt out, clinical records from 12 hospitals in the Memphis area, plus any of several county-run health clinics, are automatically sent to a common data center in Nashville run by Informatics Corporation of America. Then, when someone comes into an emergency room or visits a hospital for any other reason, the registration process brings up a screen summarizing how many times that patient—as identified by name and birthdate—has visited any of the other facilities. A doctor can click on that summary to see a chronological report—including the patients’ reported problems, their lab results, and doctor-dictated discharge summaries—from each of the hospitals.
The study found that obtaining such data was associated with a decrease in CT scans and other diagnostics as well as a reduction in hospitalizations compared to the other group, Frisse says. Administering the system costs $880,000 a year, he added, and the benefits should improve as usage increases across more departments. He added that the savings was a tiny fraction of what could be achieved in Memphis alone, especially if every doctor’s office was also linked to health-information exchanges.
In addition to saving the pregnant woman’s life, the system also allowed doctors to learn that a man who arrived in one emergency room had active tuberculosis that had been diagnosed elsewhere. This enabled the doctors to isolate the man from other patients, the researchers say.