CT Scan Study in Western New York Demonstrates How Clinical Information Exchange Can Save Money and Improve Patient Safety
In my last blog I talked about the success of HEALTHeLINK in accelerating the adoption and use of health information technology and promoting the use of electronic medical records to link patients, doctors, hospitals and health plans in Western New York.
In part two, I want to share information on how the clinical information exchange is also taking steps to eliminate waste and improve patient safety.
HEALTHeLINK recently conducted an analysis utilizing clinical data to study the number of multiple computed tomography (CT) scans ordered for the same body part, for the same patient, over a six-month time frame. The analysis was done to put a qualitative value on how many potentially unnecessary duplicative tests are being ordered by providers in Western New York – as well as potential cost savings to the region’s health system. The findings were the subject of a recent story in The Buffalo News.
The findings illustrate missed opportunities to both enhance patient safety and to reduce costs in the health systems, especially among providers who do not utilize HEALTHeLINK. Among the highlights of the analysis:
- During the 18-month study timeframe, approximately 2,763 CT scans were deemed to be potentially unnecessary duplicative tests.
- Approximately 90 percent of the potentially unnecessary duplicative CT scans were ordered by physicians who either never or infrequently used HEALTHeLINK.
- About 50 percent of the patients who had a duplicative CT scan had already consented to have their data accessed. Only 2.3 percent of the patients had denied consent.
- More than 95 percent of the identified potentially unnecessary CT scans were done in a hospital setting.
The data analyzed for this study only accounted for duplicate CT scans of three specific body parts within an 18-month period. It demonstrates a lost opportunity as well as the potential and value of health information technology and clinical information exchange for providing patients with the most effective, efficient and safe course of treatment. Keep in mind CT scans subject patients to a higher radiation dosage than conventional X-rays (100 to 1,000 times higher).
It appears that a substantial opportunity exists to help lower costs by eliminating unnecessary CT scans. Assuming an average cost of $500 per CT scan, these lost opportunities could have resulted in savings of more than $1.3 million to the Western New York health system. As this analysis took a clinically conservative look at CT scans for three specific body parts, additional savings could be achieved by reducing CT scans on other parts of the body as well as other high cost imaging such as MRIs.
When providers use the clinical information exchange and patients provide physicians access through the consent process, duplicate tests, which are often unnecessary, are far less likely to be done. In the long run, this saves time, money and most importantly in the case of CT scans, eliminates unnecessary and potentially harmful radiation exposure to the patient.
The use of medical imaging with high-dose radiation – CT scans in particular – has soared in the last 20 years, according to the National Council on Radiation Protection & Measurements.
While early diagnosis thanks to medical imaging can be lifesaving, there is growing evidence regarding the relationship between radiation and the development of cancer. A 2009 study from the National Cancer Institute estimates CT scans conducted in 2007 will cause a projected 29,000 excess cancer cases and 14,500 excess deaths over the lifetime of those exposed. Given the many scans performed over the past several years, a reasonable estimate of excess lifetime cancers would be in the hundreds of thousands.
Efforts are underway to issue criteria to help doctors consider the benefits – and risks – before ordering such a test. Much work needs to be done in this area, but we can start by eliminating potentially unnecessary tests, as evidenced by the HEALTHeLINK study.
Enhanced health information technology is a key action – on its own and in tandem with efforts to achieve greater alignment of the health system – in helping to achieve the “Triple Aim” of better health, better care and lower costs.
Michael W. Cropp, M.D., is president and CEO of Independent Health in Buffalo, New York, and Chairman of the Board of the Alliance of Community Health Plans.