By Chelsea Conaboy
The Boston Globe, March 6, 2012
Electronic health records may not be as effective as expected at reducing the number of costly and unnecessary tests doctors order for their patients, a study published Monday in Health Affairs found. Among a national sampling of more than 1,100 doctors surveyed in 2008, those who had electronic access to results of imaging tests such as CT scans and MRIs ordered more tests, not fewer.
Experts have long thought that electronic health records would save money by preventing duplicate tests through better tracking of patient care, and by providing doctors with tools to decide who would benefit from certain tests.
The most advanced records systems may be able to do that, but the ones that had been rolled out nationally when the study was done didn’t appear to be functioning well enough to do that, said lead author Dr. Danny McCormick, director of the Division of Social and Community Medicine at Cambridge Health Alliance.
The study “doesn’t say, for sure, that we would never get there with even greater resources expended. We don’t know,” he said. “But I think it raises a caution.”
The authors looked at surveys completed by doctors after 28,741 patient visits in 2008. After using statistical methods to adjust the data for variations between physician practices, researchers found that those doctors who had electronic access to imaging results were 40 percent more likely to order tests than those who had no electronic access to results.
McCormick said that electronic records have undoubtedly improved health care quality for patients and that, in his own practice, he would never choose to go back to the old way of doing things. However, he said, the nation has dedicated a lot of money to improvements in health IT — the 2009 stimulus bill set aside about $27 billion in incentives for hospitals and doctors to adopt electronic records — and policymakers must be realistic about the financial outcomes of that investment.
“If this study is right, then it’s better to know about that now, so that we can perhaps start to implement other more fundamental reforms,” he said.
He and his co-authors are advocates for a national single-payer health plan.
Dr. David Bates, chief quality officer for Brigham and Women’s Hospital, said electronic health records have come a long way since 2008, and past studies have shown that it is harder to change doctor’s habits in using imaging tests than in other things, such as ordering blood work.
But Bates said the authors are right that simply giving doctors access to information is not enough. These tools must be linked with financial incentives, he said, “so that providers are on the hook for providing more cost-effective care.”
The authors note in the study that they did not look at whether doctors’ systems included “decision support” tools, which may help physicians decide whether to order a test by providing them information about national radiology guidelines, for example, or send them an alert if they are ordering a duplicate test.
Electronic records “are not a solution,” said Dr. David Blumenthal, chief health information and innovation officer at Partners HealthCare, who served two years as President Obama’s national health IT coordinator. “They are a facilitator.”
Decision support tools are the most powerful components, he said, and the biggest benefits in cost savings and improvements in care will come when they become more widely available to doctors.
For more coverage of the study, see the following:
The New York Times: Digital Records May Not Cut Health Costs, Study Cautions
PBS NewsHour: New Study Challenges Whether Electronic Records Cut Health Costs
CNN: Could electronic medical records actually add costs?
The Washington Post: Doctors order more X-rays, not fewer, with computer access
The Wall Street Journal: Study: Electronic Access to Imaging Tests Doesn’t Curb Use
Kaiser Health News: Study: E-Health Records Don’t Deter Testing, Spending
Health Affairs blog: Electronic Access For Physicians To Prior Tests Did Not Reduce Costs