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



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.


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.


Longitudinal data analysis


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.


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.


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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Figure 1.


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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



Corresponding author

Correspondence to James E. Bailey MD, MPH.



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

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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).

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  • health information exchange
  • medical informatics
  • headache
  • headache disorders
  • migraine disorders
  • delivery of health care
  • emergency medicine
  • quality of health care
  • health services research