While imaging studies are an important part of providing care, unnecessary imaging studies are expensive, time-consuming, and can expose patients to risks such as radiation, intravenous contrast, or additional workup of incidental findings. One study found that imaging services accounted for 8% of total Medicare Part B expenditures, which equated to nearly $64 billion in 2019.1 Sharing health data through interoperability standards can improve efficiency and quality of care for patients who seek care in multiple systems.2
Providers using the Epic electronic health record (EHR) for documentation can be notified when they order an imaging study for which the patient already has a similar order or recent result. The provider can then choose whether it makes sense to continue to place the imaging order. This feature has been available for more than a decade for orders in the same instance of Epic, which can include other hospital or clinic locations within the same healthcare organization as well as independent hospitals or clinics who share an instance of Epic through the Community Connect program.
In 2021, Epic expanded this functionality to include duplicate order checking across external organizations with the release of Happy Together Imaging and Duplicate Checks Everywhere. This allows imaging orders sent from interoperable external systems to be evaluated as potential duplicate orders. As of November 2024, more than 3,000 hospitals and more than 774,000 physicians in the U.S. are connected through Epic’s Care Everywhere interoperability framework.
To better understand how these duplicate imaging order notifications influenced provider behavior, we studied more than 32.4 million notifications presented over one year. A duplicate order is considered prevented if the provider cancelled or removed the duplicate order from the notification directly, while a potentially prevented duplicate describes when a provider navigates out of the ordering activity instead of placing the order. We found that each month between 400,000 and 500,000 orders were prevented or potentially prevented, as shown in Figure 1. If each of these imaging orders were a lower cost exam like a chest x-ray, this could equate to between $310 million to $523 million dollars in savings in just one year.3 If half of these orders were a more expensive exam, such as an MRI of the chest with contrast,4 this could equate to between $1.5 billion and $2.6 billion dollars in savings in one year.
As adoption of Happy Together Imaging and Duplicate Checks Everywhere increased, we saw duplicate checks trigged by external imaging exams increase from 0.4% of duplicate imaging notifications in April 2023 to 1.1% in April 2024, an increase of 160%, equating to nearly 246,000 notifications over the study period. This could represent between $2.2 million and $10.9 million of the potential annual savings noted for duplicate imaging order notifications.
