SAN DIEGO — Over the past year, Bridget A. Stewart and her associates at Children's Hospital Boston had a hunch that duplicate testing was going on among adults with congenital heart disease who were evaluated at Children's Hospital and subsequently admitted to nearby Brigham and Women's Hospital.
“If a patient is seen at Children's Hospital and then goes immediately over to the Brigham for admission, does that admitting resident realize that you just drew a full set of labs or that you just did an EKG, or does that resident reorder everything?” Ms. Stewart, administrative director of the hospital's cardiology department, said in an interview.
She and her associates conducted a retrospective study of 86 adult congenital heart patients admitted to Brigham and Women's Hospital after postcatheterization, a postclinic visit, or a post-emergency department visit at Children's Hospital Boston between Jan. 1, 2006, and Dec. 31, 2007. Each hospital has a separate electronic medical record system.
The researchers found that 28 (32%) of the 86 patients underwent some form of duplicate testing. Of these 28 cases, 18 (64%) were deemed non-clinically relevant by two independent reviewers.
The duplicate testing, the largest source of which derived from patients who originated in the clinic at Children's Hospital Boston, resulted in $1,800 in reimbursements, based on the Medicare fee schedule.
Cardiology clinicians at Children's Hospital Boston were surprised, because “they try to mitigate duplication through communication. … The dollar value was relatively small, but they were surprised to see that 18 patients had duplication testing that was not clinically indicated,” Ms. Stewart said during a poster session at the annual conference of the Medical Group Management Association.
If the researchers followed adult congenital heart disease patients who live in Florida or Arizona for the winter months after being followed in Boston, “we'd find a lot of duplicate testing,” she added.
One solution is to develop a national integrated EMR system such as that of the Department of Veterans Affairs. “All of their computer health records are integrated,” she said. “I think that's what we need to do across America.”
One study limitation was the fact that physicians' intentions in ordering the duplicate tests were unknown. “I do not know if he looked for results in the EMR prior to ordering testing, if he ordered it to have testing results in the institution's EMR, if there was some undocumented change in patient status that we did not pick up, or if he did not trust the data from the referring facility,” said Ms. Stewart, who had no conflicts to disclose.
Clinicians were surprised to see that some of the duplicate testing 'was not clinically indicated.' MS. STEWART