ONC 2015 Edition Health IT Adoption Reduced Duplicate Orders

The Office of the National Coordinator for Health IT’s (ONC’s) 2015 Edition Health IT Certification Criteria which in turn reduced the likelihood of duplicate orders among hospitals that adopted the edition, a boon for health data interoperability, the agency celebrated. 

Unnecessary duplicate laboratory testing is common and costly. Experts estimate that in 2015, $65 billion was spent on lab testing alone, with nearly 20 to 30 percent of that used to perform unnecessary duplicate tests. Additionally, unnecessary duplicate medical imaging adds roughly $30 billion to annual US healthcare costs.

However, health IT can improve care coordination and remove inefficiencies within these domains.

The study, published in the Journal of the American Medical Informatics Association, examined the impact hospital adoption of the 2015 Edition Health IT Certification Criteria  (2015 Edition) had on duplicate lab and imaging tests.

Even though the adoption of the 2015 Edition began in 2016, most hospitals did not upgrade their EHRs that year. However, 66 percent of hospitals did adopt the 2015 Edition by the end of 2017, and more than 80 percent had adopted the 2015 criteria by the end of 2018.

Oftentimes, adoption of the certified health IT is required for participation in federal programs, such as the CMS Promoting Interoperability and Quality Payment programs, translating to high adoption rates.

There is a chance that hospital adoption of the 2015 Edition may not affect patient outcomes if the hospital does not engage in interoperable data exchange, the researchers explained.

To examine this further, the researchers assessed how the adoption of the 2015 Edition with interoperability impacted lab and imaging test duplication compared to the adoption of the 2015 Edition without interoperability.

Researchers found that hospitals that adopted the 2015 Edition were less likely to perform duplicate imaging for inpatients by 5 percentage points, implying a 50 percent reduction in imaging test duplication rates.

Hospitals that also engaged in interoperable data exchange were 2 percentage points less likely to perform duplicate imaging tests compared to hospitals with 2015 Edition but without interoperable exchange.

However, rates of duplicate lab tests among inpatients increased by 38 percent between 2014 and 2018. Interoperable hospitals that adopted the 2015 Edition were 23 percent less likely to have duplicate inpatient lab tests compared to hospitals that solely adopted the 2015 Edition.

“The association between the 2015 Edition for hospitals that engage in interoperability was significant in the inpatient setting,” the researchers stated

 “One reason could be attributed to the fact that images are more expensive than lab tests and so payers might be opportunistic in taking advantage of technology that reduces cost of care.”

“Additionally, duplications of lab tests might inherently be less sensitive to interoperable data exchange because they might be capturing aspects of health that change often and demand more frequent use of testing than images.”

The researchers also found that only 5 percent of patients in the outpatient setting had duplicate imaging tests, reducing the imaging test duplication rates by 40 percent.

In addition, hospitals that engaged in interoperability and adopted the 2015 Edition were less likely to perform duplicate imaging for outpatients.

“Results from our analysis were not robust to other specifications,” the researchers concluded.

“One reason could be attributed to the relatively short time hospitals used the 2015 Edition in our analysis,” the researcher continued. “Most hospitals that adopted the 2015 Edition had only used it for 1 or 2 years, which may not be enough time to optimize their use of new and upgraded features of this technology.”