Effect of Shared Electronic Health Records on Duplicate Imaging after Hospital Transfer
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Program on Regulation, Therapeutics, and Law, Brigham and Women’s Hospital, Boston, MA, USA; 2Harvard Medical School, Boston, MA, USA; Division of General Internal Medicine, Brigham and Women’s Hospital, Boston, MA, USA; 4Department of Medicine, South Shore Hospital, Weymouth, MA, USA.
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J Gen Intern Med DOI: 10.1007/s11606-019-05355-2 © Society of General Internal Medicine 2019
transfer (IHT) may lead to gaps in information I nterhospital between transferring and receiving care teams. Transferred patients experience higher cost per hospital day than nontransferred patients, which may be partially explained by incomplete information exchange leading to duplicate testing.1, 2 Electronic health record (EHR) interoperability presents a possible solution, allowing for instant transfer of clinical information and reducing the need to order duplicate tests.3, 4 We evaluated whether the implementation of a shared EHR reduced duplicate diagnostic imaging during IHT.
METHODS
We performed a retrospective, pre-post study involving patients transferred from a community hospital to a tertiary care hospital in Massachusetts. We included all inpatients transferred to general medicine, oncology, or cardiology services in the year before and after implementation of a shared EHR (July 2017). The primary outcome was odds of transfer with at least one duplicate imaging study. For each computed tomography (CT), magnetic resonance imaging, transthoracic echocardiogram (TTE), and non-TTE ultrasound ordered within 48 h after transfer, we used chart review to determine if a duplicate study—defined as same modality and body area—had been performed within 7 days prior to transfer. We also used two stricter definitions of duplicate images: (1) studies that utilized similar technique (e.g., contrast vs non-contrast CT) and (2) studies without a documented clinical reason. We used chi-squared and t tests to compare patient characteristics pre- versus post-shared EHR. We used univariate and multivariate logistic regression to obtain the odds of transfer Received July 31, 2019 Accepted September 11, 2019
with duplicate imaging post- versus pre-shared EHR, adjusting for demographics, admission service, calendar quarter (to account for residency training effects and seasonal case mix variation), and comorbidity and to identify independent predictors of duplicate imaging. All analyses were performed in Stata 15 (StataCorp, College Station, TX).
RESULTS
We identified 109 patient transfers in the year before and 92 patients in the year after shared EHR implementation. Patient demographics, transfer characteristics, and illness severity were similar between the two groups. A total of 209 imaging studies were ordered after transfer, of which 59 (28.2%) were duplicates. Our primary analysis demonstrated a non-significant trend toward decreased adjusted odds of duplicate imaging, postversus pre-shared EHR (Table 1). Results were similar using both stricter definitions of duplicate imaging. Transfers to the cardiology service, transfers of white no
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