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Does Health Information Exchange Reduce Unnecessary Neuroimaging and Improve Quality of Headache Care in the Emergency Department?

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Abstract

Background

Health information exchange (HIE) is advocated as an approach to reduce unnecessary testing and improve quality of emergency department (ED) care, but little evidence supports its use. Headache is a specific condition for which HIE has theoretical benefits.

Objective

To determine whether health information exchange (HIE) reduces potentially unnecessary neuroimaging, increases adherence with evidence-based guidelines, and decreases costs in the emergency department (ED) evaluation of headache.

Design

Longitudinal data analysis

Subjects

All repeat patient-visits (N = 2,102) by all 1,252 adults presenting with headache to a Memphis metropolitan area ED two or more times between August 1, 2007 and July 31, 2009.

Intervention

Use of a regional HIE connecting the 15 major adult hospitals and two regional clinic systems by authorized ED personnel to access the patient’s record during the time period in which the patient was being seen in the ED.

Main Measures

Diagnostic neuroimaging (CT, CT angiography, MRI or MRI angiography), evidence-based guideline adherence, and total patient-visit estimated cost.

Key Results

HIE data were accessed for 21.8 % of ED patient-visits for headache. 69.8 % received neuroimaging. HIE was associated with decreased odds of diagnostic neuroimaging (odds ratio [OR] 0.38, confidence interval [CI] 0.29–0.50) and increased adherence with evidence-based guidelines (OR 1.33, CI 1.02–1.73). Administrative/nursing staff HIE use (OR 0.24, CI 0.17–0.34) was also associated with decreased neuroimaging after adjustment for confounding factors. Overall HIE use was not associated with significant changes in costs.

Conclusions

HIE is associated with decreased diagnostic imaging and increased evidence-based guideline adherence in the emergency evaluation of headache, but was not associated with improvements in overall costs. Controlled trials are needed to test whether specific HIE enhancements to increase HIE use can further reduce potentially unnecessary diagnostic imaging and improve adherence with guidelines while decreasing costs of care.

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Acknowledgments

Portions of this work were funded through AHRQ Contract 290-04-0006, the State of Tennessee, and Vanderbilt University. This presentation has not been approved by the Agency for Healthcare Research and Quality. Dr. Bailey and Dr. Wan had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. We gratefully acknowledge the assistance of Mr. Mike Nesbitt of Methodist Healthcare with cost estimation methodology, Dr. Kevin Johnson of Vanderbilt University with guidance regarding methodology and patterns of HIE use, Dr. Kevin Yang and Ms. Janet King of Vanderbilt University for assistance with data extraction from the MSeHA HIE, and Drs. Chanchai McDonald, Somchan Vuthipadadon, Teeradache Viangteeravat, and Naga Satya V Rao Nagisetty with the University of Tennessee Health Science Center Slim-Prim system team of the Clinical Translational Sciences Institute for assistance with data management. A preliminary version of the study findings were presented as a poster presentation at Society of General Internal Medicine Annual Meeting, Phoenix, AZ, May 4–7, 2011 as “Mabry L, Bailey JE, Wan JY, Landy SH, Pope RA, Waters TM. Health information exchange use improves adherence with evidence-based guidelines for neuroimaging in the emergency evaluation of headache”

Conflict of Interest

The authors declare that they do not have a conflict of interest.

Author information

Authors and Affiliations

  1. Division of General Internal Medicine, Department of Medicine, University of Tennessee Health Science Center, 956 Court Avenue, Coleman D222, Memphis, TN, 38163, USA

    James E. Bailey MD, MPH, Lisa M. Mabry MD & Rebecca A. Pope MA

  2. Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA

    James E. Bailey MD, MPH, Jim Y. Wan PhD & Teresa M. Waters PhD

  3. Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, USA

    Stephen H. Landy MD

  4. Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA

    Mark E. Frisse MD, MBA

Authors
  1. James E. Bailey MD, MPH
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  2. Jim Y. Wan PhD
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  3. Lisa M. Mabry MD
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  4. Stephen H. Landy MD
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  5. Rebecca A. Pope MA
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  6. Teresa M. Waters PhD
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  7. Mark E. Frisse MD, MBA
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Corresponding author

Correspondence to James E. Bailey MD, MPH.

Appendix

Appendix

Table 4 ICD-9-CM Codes used for Primary Headache Disorders*
Full size table
Table 5 Diagnostic Codes Used to Identify Appropriate Patients for Neuroimaging According to Evidence Based Guidelines
Full size table

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Bailey, J.E., Wan, J.Y., Mabry, L.M. et al. Does Health Information Exchange Reduce Unnecessary Neuroimaging and Improve Quality of Headache Care in the Emergency Department?. J GEN INTERN MED 28, 176–183 (2013). https://doi.org/10.1007/s11606-012-2092-7

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  • DOI: https://doi.org/10.1007/s11606-012-2092-7

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