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Study: EHRs Lead to More Imaging Tests, not Less

January 25, 2017
by Rajiv Leventhal
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Although electronic health records (EHRs) are supposed to expose duplicate testing and thus reduce costs, new research has found that physicians with EHR access ordered more tests than their non-EHR counterparts.

The research, recently published in the American Journal of Managed Care, analyzed data on non–federally employed office-based physicians from the 2008 to 2012 Electronic Health Medical Records Survey, a supplement to the National Ambulatory Medical Care Survey. Researchers found that physicians who actively used an EHR system ordered more complete blood count (CBC) tests than physicians who did not, even after adjusting for patient demographics, health status, and case mix. EHR-using physicians also ordered more computerized tomography scans and x-rays.

The researchers noted that this finding contradicts “a common rationale for EHR implementation.” For the study, they analyzed several individual test-ordering practices for our primary outcomes, including complete blood count and radiographic studies, “because they are common tests, expensive in aggregate, and readily available in EHR systems.” For each test, they compared the probability of ordering by physicians using EHRs with that of physicians not using EHRs.

The study population included more than 183,000 office visits, and found that the probability that a provider would order imaging studies was significantly higher with an EHR system. Specifically, multivariate logistic regressions demonstrated that the probability of ordering a CBC test is significantly greater for physicians with EHR access—a 30 percent increase in the adjusted likelihood of ordering a CBC test compared with physicians not using an EHR after adjusting for patient demographic information and a detailed set of clinical risk-adjusters.

Extending broader to all image tests, there was a 23 percent order increase among clinics with EHRs compared to without. There was not much of a difference (6.9 percent increase) between the two groups with regard to ordering MRIs, but a 37 percent increase in x-ray orders and 41 percent increase in CT-scan orders among clinics with EHRs.

The researchers concluded, “Our results demonstrate a positive relationship between EHR implementation and the volume of laboratory and imaging tests that physicians order. Against a backdrop of policies suggesting cost savings for EHRs, these results call for reassessment of the hope that EHRs can reduce medical expenditures and increase clinical efficiency. Adopting EHRs is not enough: providers must also foster the organizational and delivery processes required to realize system wide efficiencies. Implementing EHR systems may become cost-effective only when complemented by models of care that emphasize quality, value, and efficiency.”

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