Health information exchange reduces repeated diagnostic imaging for back pain

James E. Bailey, Rebecca A. Pope, Elizabeth C. Elliott, Jim Y. Wan, Teresa M. Waters, Mark E. Frisse

Research output: Contribution to journalArticlepeer-review

91 Scopus citations


Study objective: This study seeks to determine whether health information exchange reduces repeated diagnostic imaging and related costs in emergency back pain evaluation. Methods: This was a longitudinal data analysis of health information exchange patient-visit data. All repeated emergency department (ED) patient visits for back pain with previous ED diagnostic imaging to a Memphis metropolitan area ED between August 1, 2007, and July 31, 2009, were included. Use of a regional health information exchange by ED personnel to access the patient's record during the emergency visit was the primary independent variable. Main outcomes included repeated lumbar or thoracic diagnostic imaging (radiograph, computed tomography [CT], or magnetic resonance imaging [MRI]) and total patient-visit estimated cost. Results: One hundred seventy-nine (22.4%) of the 800 qualifying repeated back pain visits resulted in repeated diagnostic imaging (radiograph 84.9%, CT 6.1%, and MRI 9.5%). Health information exchange use in the study population was low, at 12.5%, and health care providers as opposed to administrative/nursing staff accounted for 80% of the total health information exchange use. Health information exchange use by any ED personnel was associated with reduced repeated diagnostic imaging (odds ratio 0.36; 95% confidence interval 0.18 to 0.71), as was physician or nurse practitioner health information exchange use (odds ratio 0.47; 95% confidence interval 0.23 to 0.96). No cost savings were associated with health information exchange use because of increased CT imaging when health care providers used health information exchange. Conclusion: Health information exchange use is associated with 64% lower odds of repeated diagnostic imaging in the emergency evaluation of back pain. Health information exchange effect on estimated costs was negligible. More studies are needed to evaluate specific strategies to increase health information exchange use and further decrease potentially unnecessary diagnostic imaging and associated costs of care.

Original languageEnglish
Pages (from-to)16-24
Number of pages9
JournalAnnals of Emergency Medicine
Issue number1
StatePublished - Jul 2013

Bibliographical note

Funding Information:
Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see ). The authors have stated that no such relationships exist. This work was funded in part under contract No. HHSA 290-04-0006 from the Agency for Healthcare Research and Quality (AHRQ), US Department of Health and Human Services, the State of Tennessee, and Vanderbilt University.

ASJC Scopus subject areas

  • Emergency Medicine


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