By Bill Toland
Pittsburgh Post-Gazette, March 14, 2012
One rationale behind the adoption of electronic medical records is that making a patient’s records more easily accessible for doctors will result in more efficient care, partly by reducing duplicative tests.
But physicians who have electronic systems — and, more crucially, have the ability to easily order X-rays, CT scans and MRI images via computer — are far more likely to order those kinds of tests than doctors without electronic access, according to a study published in the March issue of Health Affairs.
The results of the study run counter to the experts who believe electronic access to a patient’s medical history will ultimately improve the quality and efficiency of care.
So strong is that belief that the U.S. government, via the Health Information Technology for Economic and Clinical Health Act (or HITECH), has earmarked about $30 billion to be spent spurring health providers — primarily hospitals and physicians — to use information technology.
But the report — written by researchers from Harvard Medical School, the Cambridge Health Alliance and the school of public health at Hunter College — says that “physicians’ access to computerized imaging results was associated with a 40 to 70 percent greater likelihood of an imaging test being ordered.” Lab results also were ordered at a higher rate among the computerized cohort.
“We can only speculate about what’s behind our findings,” said David Himmelstein, health policy professor at Hunter College and one of the report’s co-authors. “The most likely explanation is, if you make it easier for doctors to get a test result, [they’re] going to say, ‘Might as well go ahead and order it.’ “
The study looked at 28,741 patient visits to nearly 1,200 office-based physicians in 2008. Physicians who did not have computerized access ordered imaging tests in 12.9 percent of visits; doctors with electronic access ordered imaging in 18 percent of visits. That’s a 40 percent increase in likelihood.
When it comes to advanced imaging, the “wired” doctors were about 70 percent more likely to order such tests than those without electronic access.
The study’s authors noted “these findings raise the possibility that, as currently implemented, electronic access does not decrease test ordering in the office setting and may even increase it, possibly because of system features that are enticements to ordering.”
While advocates of electronic records have said for decades that a paperless, wired health care system would help reduce errors and cost, and increase efficiency and outcomes, the data don’t always support those findings. In fact, the data sometimes supports the opposite — that electronic records, by themselves, don’t improve care.
“The people who make their living selling or programming computers [really] don’t like the results,” Mr. Himmelstein said. “There’s nothing approaching the type of solid evidence we demand of drugs or new medical devices that come on the market” when it comes to electronic records systems, he said.
Michael Furukawa, a health economist in the Office of the National Coordinator for Health Information Technology, told The Washington Post that the study “only looked at one piece of health IT. … The proper use of advanced health IT functions, we believe, will reduce costs in the long run.”
Mr. Himmelstein, as well as skeptics of electronic records in general, respond that it’s hard to know what entails “proper use” of advanced IT functions when the systems haven’t been vetted by an independent agency.
The HITECH act, which was part of the larger economic stimulus plan, was of “clear benefit to the economy … a lot of computer equipment got bought, and a lot of jobs were created,” Mr. Himmelstein said. But whether any of that spending is now benefiting patients, “We have no idea.”
In an ideal world, management would know if a software suite is going to improve health outcomes before it’s rolled out, said Nancy Finn, a medical consultant and author of “e-Patients Live Longer.” Unfortunately, though, uncertainty is built into the process.
“The only way to know [the systems] are inefficient and flawed is to deploy them, then correct them as we go,” she said.
“That is the way that all of the new innovative technologies have worked over the years. We have to take the risk, and then improvements get made. … Once the health records are in place for a longer period of time, [I] think you will begin to see a reduction in the numbers of these tests that are being ordered.”
http://www.post-gazette.com/stories/news/health/digital-ease-may-complicate-health-care-249299/?p=0