JMIR Publications

ABSTRACT

Background:

The VA/DoD Joint Legacy Viewer (JLV) is a health information viewer supporting Department of Veterans Affairs (VA) and Department of Defense (DoD) healthcare providers with read-only access to patient medical records integrated from multiple sources. JLV is intended to support more informed medical decisions, such as reducing duplicate medical imaging when previous image study results may meet current clinical needs.

Objective:

We estimate the impact of provider usage of JLV on duplicate imaging for service members transitioning from the DoD to the VA health care system.

Methods:

We conduct a retrospective cross-sectional study in FY2018 to examine the relationship between providers’ use of JLV and the likelihood of ordering duplicate images. Our sample includes recently separated service members who had a VA primary care visit in FY18 within 90 days of a DoD imaging study. Patients who received at least one imaging study at VA within 90 days of a DoD imaging study of the same imaging mode and on the same body part are considered to have received potentially duplicative imaging studies. We use a logistic regression model with “JLV provider” (providers with 1 or more JLV audits in the prior six months) as the independent variable to estimate the relationship between JLV use and ordering of duplicate images. Control variables include provider image ordering rates in the prior six months, provider type, patient demographics (age, race, gender), and clinical characteristics (Elixhauser comorbidity score).

Results:

Providers known to utilize JLV in the prior six months order fewer duplicate images relative to providers not utilizing JLV for similar visits over time [odds ratio = 0.44; 95% CI = 0.24, 0.78, p-value = .005]. This effect is robust across multiple specifications of linear and logistic regression models. The provider’s practice pattern of ordering image studies and the patient’s health status are powerful confounders.

Conclusions:

This study provides evidence that adoption of a longitudinal viewer of health records from multiple electronic health record systems is associated with a reduced likelihood of ordering duplicate images. Investments in health information exchange systems may be effective ways to improve the quality of care and reduce adverse outcomes for patients experiencing fragmentation and discontinuity of care.