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Contrarian Study Disputes EHR Savings Wisdom

Health Affairs study contradicts conventional wisdom that EHRs will save big bucks by cutting down on needless lab and imaging testing.

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Physicians with electronic access to earlier patient test results are more likely--not less likely--to order additional tests, and actually add to overall healthcare spending, according to a new Health Affairs study based on 2008 information.

Researchers from the Harvard-affiliated Cambridge Health Alliance in Cambridge, Mass., and the City University of New York School of Public Health at Hunter College in New York found a 40% to 70% higher rate of imaging test ordering among physicians who had electronic access to results at the point of care. According to the study, published Monday in the policy journal Health Affairs, office-based doctors who could pull up results on their computers at the point of care ordered imaging tests in 18% of patient appointments, while those without electronic access did so just 12.9% of the time.

They also found higher order rates for blood tests with ready access to prior results.

The findings appear to deal a blow to the widely held belief that health IT would reduce duplicative testing and thus help rein in costs. "It sort of runs contrary to what most people think," lead author Dr. Danny McCormick, director of the Division of Social and Community Medicine at Cambridge Health Alliance, told InformationWeek Healthcare. "For years, a lot of people in the health policy world have made the argument that health IT will bring cost savings."

[ For more background on e-prescribing tools, see 6 E-Prescribing Vendors To Watch. ]

Interestingly, there was no evidence that the presence of electronic health records (EHRs) alone led to more test orders. There had to be electronic access to test results. "These findings raise the possibility that, as currently implemented, electronic access does not decrease test ordering in the office setting and might even increase it, possibly because of system features that are enticements to ordering. We conclude that use of these health information technologies, whatever their other benefits, remains unproven as an effective cost-control strategy with respect to reducing the ordering of unnecessary tests," the Health Affairs article said.

However, the study is based on 2008 data from the annual National Ambulatory Medical Care Survey by the federal Centers for Disease Control and Prevention (CDC), when fewer systems were connected. "I think it's fair to say that in 2008, health IT appears not to save money, at least in terms of ordering tests, but there are a lot of caveats," McCormick said.

EHR usage in the U.S. has grown considerably since 2008, thanks in part to the federal Meaningful Use incentive program, though not as quickly as some have hoped. But health information exchange between facilities and organizations has lagged. "We're not very far down the road to interoperability," McCormick said.

According to McCormick, the CDC database does not show whether a physician had access to a health information exchange at the time of the patient encounter, nor is there any information about physicians having financial stakes in imaging centers. It also does not indicate why doctors ordered tests. "It really begs the question, 'What is the physician motivation?'," McCormick said.

The researchers examined data from 28,741 patient visits at 1,187 physician offices, not counting hospital outpatient departments. They also excluded radiologists, anesthesiologists, and pathologists from the study.

McCormick and two of the other three authors, Dr. Steffie Woolhandler and Dr. David Himmelstein, are board members or officers of single-payer advocacy organization Physicians for a National Health Program. They do not discuss their involvement with the group in the Health Affairs paper.

Healthcare providers must collect all sorts of performance data to meet emerging standards. The new Pay For Performance issue of InformationWeek Healthcare delves into the huge task ahead. Also in this issue: Why personal health records have flopped. (Free registration required.)

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