title: Health information exchange reduces repeated diagnostic imaging for back pain.
abstract: OBJECTIVE
  This study seeks to determine whether health information exchange reduces repeated diagnostic imaging and related costs in emergency back pain evaluation.
  
  
  METHODS
  This was a longitudinal data analysis of health information exchange patient-visit data. All repeated emergency department (ED) patient visits for back pain with previous ED diagnostic imaging to a Memphis metropolitan area ED between August 1, 2007, and July 31, 2009, were included. Use of a regional health information exchange by ED personnel to access the patient's record during the emergency visit was the primary independent variable. Main outcomes included repeated lumbar or thoracic diagnostic imaging (radiograph, computed tomography [CT], or magnetic resonance imaging [MRI]) and total patient-visit estimated cost.
  
  
  RESULTS
  One hundred seventy-nine (22.4%) of the 800 qualifying repeated back pain visits resulted in repeated diagnostic imaging (radiograph 84.9%, CT 6.1%, and MRI 9.5%). Health information exchange use in the study population was low, at 12.5%, and health care providers as opposed to administrative/nursing staff accounted for 80% of the total health information exchange use. Health information exchange use by any ED personnel was associated with reduced repeated diagnostic imaging (odds ratio 0.36; 95% confidence interval 0.18 to 0.71), as was physician or nurse practitioner health information exchange use (odds ratio 0.47; 95% confidence interval 0.23 to 0.96). No cost savings were associated with health information exchange use because of increased CT imaging when health care providers used health information exchange.
  
  
  CONCLUSIONS
  Health information exchange use is associated with 64% lower odds of repeated diagnostic imaging in the emergency evaluation of back pain. Health information exchange effect on estimated costs was negligible. More studies are needed to evaluate specific strategies to increase health information exchange use and further decrease potentially unnecessary diagnostic imaging and associated costs of care.
authors: Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA. jeb@uthsc.edu
authors: James E
authors: JE
authors: Bailey
authors: Rebecca A
authors: RA
authors: Pope
authors: Elizabeth C
authors: EC
authors: Elliott
authors: Jim Y
authors: JY
authors: Wan
authors: Teresa M
authors: TM
authors: Waters
authors: Mark E
authors: ME
authors: Frisse
mesh_terms: D000328:Adult; D000368:Aged; D016001:Confidence Intervals; D017046:Cost Savings; D003952:Diagnostic Imaging / Q000379:methods* / Q000706:statistics & numerical data; D057286:Electronic Health Records / Q000458:organization & administration; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D063005:Health Information Systems / Q000458:organization & administration*; D006801:Humans; D033181:Information Dissemination; D008137:Longitudinal Studies; D017116:Low Back Pain / Q000175:diagnosis* / Q000453:epidemiology; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D014057:Tomography, X-Ray Computed / Q000379:methods / Q000706:statistics & numerical data; D014481:United States; D019564:Unnecessary Procedures / Q000706:statistics & numerical data*