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Study: EHRs Do Not Reduce Costs, Additional Testing

March 6, 2012
by Gabriel Perna
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A new study from researchers at Harvard Medical School, the Cambridge Health Alliance and the City University of New York says doctors’ access to patients’ test results will not reduce testing or costs. The study says doctors who have access to patients results in the ambulatory care setting via electronic health records (EHRs) are more likely to order imaging and lab tests.

The study, which appears in the March issue of the journal Health Affairs, challenges a somewhat accepted premise of increased adoption of health information technology. Instead, researchers say the results could drive costs up.  

“Our findings should at a minimum raise questions about the whole idea that computerization decreases test ordering and therefore costs in the real world of outpatient practice,” lead author Danny McCormick, a physician and assistant professor of medicine at Harvard Medical School, said in a statement. He adds that as with many other things, if you make things easier to do, people will do them more often.

McCormick co-wrote the paper with David Bor, chief of medicine at Cambridge Health Alliance, and Stephanie Woolhandler and David Himmelstein, both professors of public health at the City University of New York.  For their study, McCormick and colleagues analyzed data from the 2008 National Ambulatory Medical Care Survey, which includes 28,741 patient visits to a national sample of 1,187 physician-based offices. The survey excludes hospital outpatient departments and offices of radiologists, anesthesiologists, and pathologists.

According to McCormick, point-of-care electronic access to electronic imaging results, sometimes through an EHR, was associated with a 40–70 percent greater likelihood of an imaging test being ordered. Physicians without such access ordered imaging in 12.9 percent of visits, while physicians with access ordered imaging in 18.0 percent of visits.

Other studies have estimated that computerization in physician offices would save as much as $8.3 billion a year on imaging and lab testing. However, researchers from McCormick’s study say these studies were based on incomplete data, using few, flagship institutions with cutting-edge systems, and not generalize to current medical practice, where computer technology is off-the-shelf.  With this in mind, the researchers say office-based computerization may not yet reduce imaging use because current systems are cumbersome, insufficiently interoperable, or lack effective decision-support software.

While McCormick and his researchers say that they are not criticizing investments in HIT, they contend that their findings emphasize the importance of establishing the benefits of computerization rather than estimating them in the absence of data, or generalizing from small studies at a few atypical institutions.

The full study is here: http://www.healthaffairs.org/Media/toc/2012_03_toc.pdf

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