New EHR certification requirements and their association with duplicate tests and images

Area of Science:

• Health Informatics
• Health Services Research
• Medical Technology Assessment

Background:

• Most hospitals and healthcare providers have adopted certified electronic health record (EHR) technology.
• The Office of the National Coordinator for Health Information Technology (ONC) released the 2015 Edition EHR certification requirements.
• Previous research has not evaluated the impact of the 2015 Edition adoption on healthcare delivery.

Purpose of the Study:

• To examine the impact of hospitals' adoption of the 2015 Edition EHR certification on the incidence of duplicate lab and imaging tests.
• To assess whether EHR adoption influences the duplication of medical tests in inpatient and outpatient settings.

Main Methods:

• Analysis of deidentified health insurance claims data from FAIR Health (representing ~75% of privately insured individuals in the US).
• Linking claims data with the American Hospital Association (AHA) Information Technology Supplement Survey for hospital IT characteristics.
• Utilizing a fixed effects model to compare duplicate testing and imaging rates before and after hospitals adopted the 2015 Edition EHR standards.

Main Results:

• Hospitals adopting the 2015 Edition showed a 5 percentage point (50% from baseline) reduction in duplicate inpatient imaging.
• Hospitals using the 2015 Edition and engaging in interoperable data exchange demonstrated an even greater reduction in duplicate lab tests.

Conclusions:

• Adoption of the 2015 Edition certified EHR was associated with a decrease in duplicate lab and imaging tests across inpatient and outpatient settings.
• The observed effects were not consistently robust across all analytical specifications.
• While EHR certification standards can help reduce unnecessary duplicate tests, they are insufficient on their own to eliminate the problem, as multiple factors influence care delivery decisions.