One in 10 of the three most common CT scans done in Western New York is likely an unnecessary duplication that wastes money and poses a radiation risk to the patient, according to a new study.
An estimated 2,763 of 27,229 scans included in the review were deemed potentially unnecessary, according to HEALTHeLINK, a nonprofit consortium of hospitals, insurers and other medical groups in Western New York that conducted the study.
HEALTHeLINK promotes the use of electronic medical records to link patients, doctors and insurers in the region.
BlueCross BlueShield of Western New York, Independent Health and Univera Healthcare – three insurers in the consortium that provide coverage to about 65 percent of the commercially insured residents in the region – provided CT scan claims data from July 1, 2011, through Dec. 31, 2012.
HEALTHeLINK found that about 90 percent of the potentially unnecessary CT scans of the chest, abdomen, and head and neck were ordered by physicians who either infrequently used or did not use HEALTHeLINK at all. More than 95 percent of the duplicative scans were done in a hospital, according to the study.
“The CT scan is the tip of the iceberg. The study demonstrates our inability now to get a full picture when we see a patient,” said Dr. David O. Scamurra, chairman of the HEALTHeLINK board of directors.
The duplicated efforts cost an estimated $1.3 million, according to the study, based on an average cost of $500 per CT scan.
The study concluded that even more could be saved by eliminating unnecessary scans. The study examined CT scans for only three parts of the body and did not include other imaging technologies, such as magnetic resonance imaging, or MRI.
CT, or computed tomography, combines many X-ray images to create cross-sectional views of the body or, if needed, three-dimensional images of internal structures. Doctors commonly use the scans to examine traumatic injuries, tumors and problems in organs.
HEALTHeLINK conducted the study, in collaboration with local health insurers, to make the case for wider use of its electronic health information exchange. The exchange allows patient information to be shared among hospitals, insurers, doctors’ offices and other medical facilities.
HEALTHeLINK receives financial support from its charter members: Kaleida Health, Catholic Health, Erie County Medical Center, Roswell Park Cancer Institute, BlueCross BlueShield, Independent Health and Univera.
Health information exchanges have formed across the country.
Officials said that resistance by physicians to take the time to use the system on their computers when they see a patient remains a challenge.
“The problem is not about acceptance. It’s about the efficiency of using it on a day-to-day basis,” said Daniel E. Porreca, executive director of the organization.
Advocates contend that electronic sharing of patient data among medical providers helps lead to better coordinated care and increased efficiency, as well as fewer errors and duplicated services.
Nearly 600,000 patients in the region – 40 percent of all adults – have given consent for their medical records to be included in HEALTHeLINK. All of the area hospitals are linked to the system.
In addition, HEALTHeLINK now provides 98 percent of the laboratory results and 95 percent of the radiology reports generated in the region, according to the organization.
Use of the exchange has grown. There were more than 610,000 queries for patient data in 2013, compared with 197,000 in 2011 and 4,000 in 2009. As more patients include their records and more people in health care use the exchange, its value will increase, officials said.
“We are at a tipping point in the community with the potential for exponential growth,” said Dr. Thomas J. Foels, chief medical officer at Independent Health.
Foels stressed the need to eliminate waste, since there are more expensive diagnostic tests on the horizon.
CT technology uses computer software to piece together multiple X-rays, which provide doctors important information by making internal body parts more visible than a conventional X-ray. The use of CT scans has soared over the last few decades.
The findings in the study underscore the danger of repeated exposure to radiation. A CT scan exposes patients to a radiation dose potentially hundreds of times higher than a conventional X-ray.
That has led to concern over developing cancer from the radiation, especially in children. Between 1996 and 2010, the rate of CT use almost tripled, from 52 scans per 1,000 patients to 149 per 1,000, according to 2012 study in the Journal of the American Medical Association.
Medical and insurance officials here cited a host of reasons for the overuse, including fear of liability, the unreliability of patients’ memories of tests, poor communication between doctors, and profit motives.
“You need to appreciate how little we as doctors know, how poorly we communicate,” said Scamurra, the HEALTHeLINK chairman.
“A patient comes into the hospital, and there is nothing in front of you that says don’t order a CT. I may not know the patient’s primary care doctor, and, if I do, I may not get through to that doctor quickly enough,” he said. “You treat patients today as though they are a blank slate.”
Daniel R. Bednarek, Ph.D., who co-authored a report for the Image Wisely educational campaign, said patients can help by telling their doctors of previous tests, asking whether the area of the body to be scanned can be limited and, in the case of a child, making sure the dose is size-specific.
“There are things patients can do, but they also have to weigh the benefits against the risks,” said Bednarek, a radiation safety officer at ECMC. “The CT is an incredible tool. It allows us to see inside the body.”