title: Image Sharing Technologies and Reduction of Imaging Utilization: A Systematic Review and Meta-analysis.
abstract: BACKGROUND
  Image sharing technologies may reduce unneeded imaging by improving provider access to imaging information. A systematic review and meta-analysis were conducted to summarize the impact of image sharing technologies on patient imaging utilization.
  
  
  METHODS
  Quantitative evaluations of the effects of PACS, regional image exchange networks, interoperable electronic heath records, tools for importing physical media, and health information exchange systems on utilization were identified through a systematic review of the published and gray English-language literature (2004-2014). Outcomes, standard effect sizes (ESs), settings, technology, populations, and risk of bias were abstracted from each study. The impact of image sharing technologies was summarized with random-effects meta-analysis and meta-regression models.
  
  
  RESULTS
  A total of 17 articles were included in the review, with a total of 42 different studies. Image sharing technology was associated with a significant decrease in repeat imaging (pooled effect size [ES] = -0.17; 95% confidence interval [CI] = [-0.25, -0.09]; P < .001). However, image sharing technology was associated with a significant increase in any imaging utilization (pooled ES = 0.20; 95% CI = [0.07, 0.32]; P = .002). For all outcomes combined, image sharing technology was not associated with utilization. Most studies were at risk for bias.
  
  
  CONCLUSIONS
  Image sharing technology was associated with reductions in repeat and unnecessary imaging, in both the overall literature and the most-rigorous studies. Stronger evidence is needed to further explore the role of specific technologies and their potential impact on various modalities, patient populations, and settings.
authors.affiliation: Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, New York. Electronic address: joshvest@iu.edu.
authors.forename: Joshua R
authors.initials: JR
authors.lastname: Vest
authors.affiliation: Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, New York.
authors.forename: Hye-Young
authors.initials: HY
authors.lastname: Jung
authors.affiliation: Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, New York.
authors.forename: Aaron
authors.initials: A
authors.lastname: Ostrovsky
authors.affiliation: Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, New York; Greenberg Division of Cardiology, Weill Cornell Medical College, New York, New York.
authors.forename: Lala Tanmoy
authors.initials: LT
authors.lastname: Das
authors.affiliation: Department of Radiology, Weill Cornell Medical College, New York, New York; New York-Presbyterian Hospital, New York, New York.
authors.forename: Geraldine B
authors.initials: GB
authors.lastname: McGinty
mesh_terms: D003952:Diagnostic Imaging / Q000706:statistics & numerical data*; D017598:Efficiency, Organizational / Q000706:statistics & numerical data*; D057286:Electronic Health Records / Q000706:statistics & numerical data*; D006755:Hospital Shared Services / Q000706:statistics & numerical data; D038622:Internationality; D000069342:Medical Overuse / Q000517:prevention & control* / Q000706:statistics & numerical data*; D011873:Radiology Information Systems / Q000706:statistics & numerical data*; D014600:Utilization Review
keywords: Health information exchange; data sharing; evaluation; radiology information systems; utilization