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Let's Get Going

October 1, 2006
by David Kates and David Kaplan
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Health systems should start focusing on how to best share diagnostic images.

Most readers will agree that there are tremendous improvements to be attained through the sharing of healthcare information across organizational boundaries. The benefits include having more complete and accurate information at the point-of-care, more informed and timely clinical decisions, fewer medical errors, and a reduction in redundant healthcare services.

Despite all of the apparent benefits, governance, political, technical, and business issues have precluded most regional health information organizations (RHIOs) from achieving their goals to date.

Cambridge, Mass.-based Forrester Research recently studied the more than 100 RHIOs that have formed over the past several years and found that only seven had achieved the mission of successfully moving patient data across a broad set of competing provider institutions. While the reasons for the under 10 percent success rate are numerous, we believe that the prioritization of which types of health information to exchange can play a large part in the success or failure of health information exchange (HIE) efforts.

Where to start with HIE?

Conventional wisdom suggests that medication history and laboratory results sharing should top the list — and this is where many RHIOs have begun. There is just so much money being spent on prescription drugs, and there are so many lab tests that get ordered, there just must be inordinate amounts of money that can be saved and health outcomes that can be improved, the thinking goes.

But as John Kenneth Galbraith (the economist who coined the term conventional wisdom) explains, "The conventional view serves to protect us from the painful job of thinking." Sharing lab and medication information is unquestionably important for the effective and efficient delivery of quality healthcare. Though usually farther down on the priority list, it turns out that the hard dollar savings available by sharing diagnostic imaging information are greater than those from lab and medication information. Furthermore, the benefits from exchanging radiology studies are actually more readily achievable today.

Focus on "hard" savings

Based on data from the Center for Information Technology Leadership referenced in the table below, the potential financial savings from sharing all types of health information is enormous. When evaluating these savings, it is important to distinguish between "hard" and "soft" benefits. Hard savings are those that can be monetized and can reasonably be expected. Soft benefits include those that have non-monetary value or require substantial organizational or process changes and are therefore less likely to be readily achieved.

The hard savings from the exchange of health information are in the elimination of redundant procedures or testing as a result of having access to those existing clinical results. Breaking down the savings from HIE that way, the table shows how sharing, diagnostic imaging (radiology) information offers 64 percent greater hard dollar savings versus laboratory and pharmacy combined.

In addition to greater hard cost savings, the factors making the savings from interoperability for imaging data more readily attainable include:

  • Diagnostic imaging information is already predominantly stored digitally today. Device manufacturers have universally implemented the DICOM standard for years. Other forms of medical information sharing are dependent on the adoption of electronic medical records (EMRs) as well the development of interoperability standards to share information between users of various EMR systems.

  • Radiology services are usually delivered by hospitals or local imaging chains in which no one player is dominant. This contrasts to other areas in which there are large players with substantial influence that might have financial or political disincentives to make information readily accessible to competing institutions.

  • There is substantial motivation for all parties to eliminate redundant imaging. At $100 billion in annual spending across the United States, diagnostic imaging is now the second largest — and fastest growing — spend item for healthcare payers. As a response to this explosive growth, payers are increasingly deploying draconian radiology-utilization-management techniques (such as preauthorization) that call the physician's medical judgment into question and can also be perceived as limiting patient access to the best care. The elimination of redundant imaging is a much more benign form of radiology-utilization management that reduces unnecessary cost for payers, while providing benefits to both the provider and the patient.

Touching all

In addition to the benefits that are both larger and easier to attain compared to other types of medical information, the exchange of diagnostic imaging provides tangible benefits for all key healthcare stakeholders.