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What’s in a Study?

March 20, 2012
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The results of a recent HIT study have generated controversy and discourse

Research studies and the healthcare industry go together like peanut butter and jelly. As long as medical research institutions have existed, there have been countless studies attempting to prove and disprove every little thing under the sun related to healthcare. I can’t tell you how many times I’ve read something that declares red meat to be either the unhealthiest or healthiest thing you can consume. The old saying, an apple a day keeps the doctor away? Someone actually did a study to prove that!

Because of how omnipresent studies are in the healthcare industry, I couldn’t help but be slightly intrigued at the recent back-and-forth between Farzad Mostashari, M.D, the National Coordinator for Health IT, and Danny McCormick, M.D., an assistant professor of medicine at Harvard Medical School. Studies of this nature are published all the time; but clearly the publication of this one in Health Affairs has engendered strong reactions, even at the highest level.

For those who don’t know, McCormick authored a controversial study with a team of researchers from the Cambridge Health Alliance and the CUNY School of Public Health that concluded electronic access to computerized imaging results not only doesn’t decrease the amount of imaging tests ordered by physicians, but it actually increases that number. The study examined 28,741 patient visits to 1187 office-based physicians with samplings from the National Ambulatory Medical Care Survey (NAMCS).

In response to the study, which was published in Health Affairs, Mostashari went out of his way to discredit the results as much as possible in a blog post. Included in his criticisms of the study, Mostashari said the study didn’t look at EHRs and their impact on test ordering, he said they used outdated research from 2008 and didn’t take into account clinical decision support (CDS). He also said the study didn’t account for variables such as sicker patient population, level of physician training and financial arrangements.

McCormick fired back a few days later with his own carefully crafted response. He made an effort to refute each of Mostashari’s points, especially about the variables, saying the researchers undertook a subsidiary multivariate analysis to account for those variables. I also got a chance to speak with McCormick about the results and his own opinions about what they say in terms of the overall picture.

In some ways, the results of this study go against the whole notion that health IT is cost-effective for healthcare organizations.  Hearing this, naturally, doesn’t sit well with Dr. Mostashari, who champions the use of health IT every day in his role. I can see why he would be quick to dismiss it. It is part of his job to convince others to use health IT and studies like this might be damaging to his cause.

Still, while some studies may be inaccurate, excessive and draw conclusions based on non-existent research, others are well thought out and a part of figuring out trends in important healthcare. They can help ask the questions that solve critical issues. The efficiency and cost-effectiveness of health IT systems are questions most CIOs are asking themselves today. It’s only natural that someone would ask this question and research it.

There have been studies that have reported positive results in terms of clinical information systems reducing duplicate test results. One such study came from the Center for Applied Medical Information Systems in Boston, which found clinical e-alerts reduced duplicate testing by 69 percent. Meanwhile, McCormick’s study isn’t the only one that has suggested perhaps health IT doesn’t save money, but actually increases costs.

No one is saying the results are definitive. Mostashari himself basically said that over time the truth will play out and that it’s too early to jump to any conclusions.  And I agree. That’s why continued research in this area will be important. Meanwhile, the discourse will continue and as well it should.  

What do you guys think about this back-and-forth?



I think both parties missed the point. The study did not measure cost of use of EHR, it measured that when provider have access to online radiology review, they ordered more studies. It says nothing about what would happen when using an integrated EMR, CPOE, and PACS system which the more modern HIT systems now incorporate.
Ted Palen, MD

Thanks Ted for the reply. I agree there is a lot more research that can be done, in terms of valuing the cost-reduction or cost-increases that come with an integrated EMR, CPOE and PACS, as well as anything with clinical decision support.