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8/30/2011
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How One Health Information Exchange Cut Testing Costs

Payoff on HIEs can be hard to calculate, but analysis of a Wisconsin pilot program showed clear savings via elimination of duplicate tests.

Health IT Boosts Patient Care, Safety
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Slideshow: Health IT Boosts Patient Care, Safety
According to a study from Humana and the Wisconsin Health Information Exchange, when health information exchanges (HIEs) are used in emergency departments, providers avoid duplicating the number of imaging procedures and diagnostic tests they perform which results in significant cost savings.

The peer-reviewed analysis, which was published in the July/August issue of American Health & Drug Benefits, sheds new light on the value HIEs can have on healthcare costs at a time when patient models of care seek to squeeze expenses out of the system while improving the quality of care.

The analysis included 10 Milwaukee hospitals where 1,482 fully insured Humana members in Southeast Wisconsin sought emergency department care. Doctors and other clinical workers at the emergency department used the HIE to access and view patients' historical medical encounter information to help them make diagnosis and treatment decisions.

Researchers found that four of the top five emergency department-based procedures conclusively showed reductions in the number of tests, including CT scans, EKGs, laboratory testing, and diagnostic radiology, when the patient database was queried by clinicians. The reduced number of tests was, in part, due to an ability to cross-check previous tests on the HIE network, which helped avoid repeating the same test in the emergency department. The results translated to an estimated average savings of $29 per emergency department visit, which helped to control costs.

"What surprised me most was the actual dollar impact, the $29 savings per ED visit that we achieved," Dr. Albert Tzeel, the study's author and HumanaOne's national medical director, told InformationWeek Healthcare. "When we first agreed to run this pilot, we felt in our hearts that we knew that savings would accrue; we just didn't know how much. So, when we saw the results, we were extremely pleased."

Tzeel also noted that the study confirmed that the more information physicians have at their disposal to care for patients at the point of care, the more likely those physicians are to provide better care.

He also observed that many HIEs have either been established or are being established using public dollars. This model may provide the initial impetus to start an exchange, but given the country's economic crisis, it's unsustainable in the long run, he said.

"What this study shows is that, since health plans get an economic benefit through supporting and helping sustain HIEs, we can get a true win-win-win-win: health plans win by saving money in the care of their members, HIEs win by finding a method of revenue generation that allows them to become sustainable outside of public monies, doctors win because they get the information they need to better take care of their patients, and patients win because they get better care. Ultimately, the healthcare system as a whole wins because we see better care provided, improved efficiency, and decreased waste," Tzeel said.

Participants in the study were fully insured plan members who sought emergency department care on at least two occasions during the study period, from December 2008 through March 2010. The study evaluated the effectiveness of community-based HIEs, which included examining the secure exchange of healthcare-related data among facilities, health information organizations, and government agencies, for patients seeking care at emergency departments.

Kim Pemble, executive director of the Wisconsin Health Information Exchange, said in a statement that historically it has been difficult to measure the economic value of health information exchanges; however, this research highlights the value HIEs can provide for health plans, as well as providers and patients.

"Hopefully, HIE initiatives will see a rise in the adoption and support of this technology by health plans as a result of the increasing validation of its numerous benefits, including cost savings, patient safety, and improved care coordination," Pemble said.

Find out how health IT leaders are dealing with the industry's pain points, from allowing unfettered patient data access to sharing electronic records. Also in the new, all-digital issue of InformationWeek Healthcare: There needs to be better e-communication between technologists and clinicians. Download the issue now. (Free registration required.)

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