Health Information Exchange and Ambulatory Test Utilization

Health information exchanges (HIEs) may improve the quality and efficiency of medical care because clinicians are able to make better decisions when the health information they need is easily accessible. In addition, HIEs are expected to reduce health care costs, partially by reducing redundant laboratory and radiology tests. Research suggests that when institutions implement electronic medical records (EHRs), the utilization of tests is substantially reduced because clinicians who have ready access to the results of prior tests are less likely to repeat those tests. Although it is intuitive that a similar result would occur from information exchange across communities with an HIE, there is little evidence to support this.

This study evaluated whether the adoption of a community-wide HIE reduces utilization and costs of laboratory and radiology testing. The study took place in Mesa County, Colorado, where there has been wide-scale adoption of the Quality Health Network, the regional HIE. The specific aim of this project was to:

• Determine whether adoption of HIE in Mesa County, Colorado, is associated with a reduction in test ordering. 

The project used a retrospective, pre-post study design comparing providers working in Mesa County medical practices. The analyses took place at both the practice and the provider level. Claims data were used and matched to HIE adoption data. The effect of HIE adoption on testing rates and associated charges was assessed.

In the ambulatory setting, provider adoption of HIE was not associated with consistent reductions in overall rates of testing with HIE or of costs of testing. The project team concluded that ambulatory HIE adoption is unlikely to produce significant direct savings through reductions in rates of testing. The economic benefits of HIE may reside instead in other downstream outcomes of better informed, more coordinated, and higher-quality care.