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Surprise! EHR Use Doesn’t Magically Cut Costs

March 7, 2012
Written by: , Filed in: Diagnostic Imaging, Practice Management
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Adoption of electronic health records (EHR) will reduce spending on imaging, right? If doctors have access to past test results and medical records, then they won’t have to order so many new tests. And clinical decision support, built into some EHR systems, forces doctors to justify any tests they order.

That’s the theory. However, that’s not how it works in practice, according to a new study in the March issue of Health Affairs. The study found that physicians who had access to computerized imaging results (sometimes, but not always, via an electronic health record) were 40 to 70 percent more likely to order an imaging test than physicians who had access only to paper records.

Physicians who had electronic access to lab test results also ordered more blood tests than physicians who didn’t.

Lead author Danny McCormick, MD, an assistant professor of medicine at Harvard Medical School in Boston, told The New York Times:

Our research raises real concerns about whether health information technology is going to be the answer to reducing costs.

The study had limitations. It used 2008 data, so full EHR systems, hardly ubiquitous even today, were even less common then. According to the Times article, EHR proponents criticized the study for using data from a survey intended for a different purpose and said its results conflicted with those from other research.

Dr. McCormick responded that most of that other research was based on statistical models or real-world experience at a small number of  “flagship” health systems. In contrast, he said, “We looked at not just a few cutting-edge institutions, but a nationally representative sample.”

I haven’t done any research, or even any statistical modeling, but I do know that when you give human beings access to more tools, they’re generally going to use those tools. And doctors are getting access to new imaging tools practically by the minute.

Powerful forces have propelled the increase in the use of medical imaging over the past few decades. They include, but are not limited to, spectacular improvements in imaging quality, much wider availability of scanners, fear of malpractice suits pushing doctors toward defensive medicine, expanded coverage of imaging by insurance, and, yes, economic pressures to get profitable use from expensive imaging machines.

To think that, all by itself, the adoption of electronic health records is going to stop or even significantly counteract those forces is, at best, wishful thinking.

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