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The electronic medical record (EMR) has been promoted as a tool to reduce health care costs by preventing duplicate testing, amongst other benefits. However, payments to institutions which have adopted EMR have actually increased. While much of this increase in cost has been attributed to more aggressive billing and higher coding, there is little data to suggest that the use of EMR has reduced duplicate testing. We sought to evaluate the rate of ordering of repeat transthoracic echocardiograms (TTE) before and after the institution of EMR at our teaching hospital.
All TTE's ordered in the period of 1 year prior to, and 1 and 2 years after the implementation of EMR were reviewed to assess the number of patients who underwent duplicate testing within 6 and 12 months of the index TTE. All appropriate repeat exams done for a focused question and/or specific follow-up were excluded. The indication for ordering the repeat exam was noted.
We observed a significant increase in the ordering of duplicate TTE's after the institution of EMR. In the first year after EMR there was an increase in the ordering of a repeat TTE of 43% within 6 months and 69% within 12 months of the index examination. This trend continued in year 2 of EMR use. We hypothesize that the ease of ordering and usage of electronic order sets provided by EMR has contributed to an increase in repeat testing. Duplicate testing may partially explain the increased costs observed with EMR
|July 2007 – June 2008 (Pre-EMR)||July 2009 – June 2010 (EMR year 1)||July 2011 – June 2012 (EMR year 2)||P Value (for comparison of pre-EMR to both 1 and 2 years post-EMR)|
|Total patients undergoing TTE||10399||7103||7317|
|Patients undergoing repeat TTE within 6 months of index echo||479 (4.6%)||471 (6.6%)||419 (5.7%)||<0.01|
|Change in duplicate testing rate with EMR at 6 mos.||+43%||+24%|
|Patients undergoing repeat TTE within 12 months of index echo||792 (7.6%)||916 (12.9%)||840 (11.5%)||<0.01|
|Change in duplicate testing rate with EMR at 12 months.||+69%||+51%|
|Most common indications for repeat examination|
West, Room 3006
Sunday, March 10, 2013, 8:45 a.m.-9:00 a.m.
Session Title: Advancing the Cutting Edge of Cardiovascular Care: Recent Accomplishments and Future Goals
Abstract Category: 28. Quality of Care and Outcomes Assessment
Presentation Number: 920-6
- 2013 American College of Cardiology Foundation