Ask anyone who grew up singing and dancing in the 1980’s to hum a few bars from the great American musical “All that Jazz,” and they will likely belt out “everything old is new again!” But sadly, despite Peter Allen’s iconic lyrics, not everything ought to be new again. A perfectly good imaging test, for example, doesn’t need to be made new again. Yet patients and providers frequently experience a frustrating lack of access to prior imaging studies. A few years ago, as a new patient to a health system, I was told that I needed a CT scan, although one was recently done by my previous provider. This was frustrating, but even more maddening were the phone transfers, prolonged hold times, and ultimately, my failed attempts to obtain the films myself.
Cost of Care
The U.S. spends twice as much on healthcare as any other high-income country in the world, and diagnostic imaging accounts for 10% ($100 billion) of our total annual healthcare costs. Medicare, alone, spends $10 billion annually on medical imaging. Among high-income countries, the U.S. has the second highest number of imaging exams and the second highest MRI and CT technology utilization rate, following Japan.
Despite efforts to curb exorbitant imaging costs, between 6 to 9% of radiology studies are unnecessary or redundant. A recent study revealed that the highest rate of imaging duplication in common procedures is for x-rays (8.2%) and ultrasound (9.6%), and although CT and MRI tests represent only 12.8% of repeated tests, avoidance of these duplicate scans account for half of the estimated cost savings.
During my CT scan fiasco, I experienced, first-hand, a patient’s perspective on the challenge of accessing prior films. However, as a physician, I endured countless instances on the flip side of the story. During my time as a pediatric hospitalist, there were many times where, despite my best efforts, I could not obtain a patient’s outside films. However, to treat a child recently seen by another provider, a time-series comparison of images is frequently necessary – especially when the patient’s condition is not improving. Yet the inability to obtain prior films often left me with no choice but to order duplicate studies.
The lack of access to outside imaging is particularly grave for patients with high acuities – such as trauma patients. Attempting to obtain previous images can cause, on average, up to a 25 minute delay in treatment. In abdominal trauma patients, for example, this delay can mean the difference between life and death: a recent study found that 80% of blunt abdominal trauma patients who experienced a delay greater than 60 minutes died at the ED.
Where do we go from here?
In the past decade, the world of imaging has made great strides to combat challenges like these. Ironically, radiology was the first clinical specialty to adopt a digital model. I remember the disbelief and excitement we felt when our hospital implemented a PACs system. We have come a long way since then. Enterprise imaging initiatives are now top of mind for most health systems, and technologies such as vendor neutral archives (VNAs) and third-party connectivity apps are playing a significant part in improving the way we import and share images.
Additionally, as patients increasingly take an active role in their care, the “patient-as-a-consumer” movement has driven much needed change in traditional care delivery models. Imaging is no exception. Burdened with transporting CDs of old films and repeating unnecessary tests, patients are more vocal about changing in this antiquated model, and health systems are listening. Maybe it’s time to move that Peter Allen song to the “oldies” playlist, and start humming another 1980’s anthem: “We’re not gonna take it…”