BACK AND FORTH: The Debate Over Electronic Health Records
A study published this week in the journal Health Affairs has raised the ire of the health IT world, after it found that electronic health records could encourage physicians to order imaging tests more frequently and raised questions about whether the technology can help reduce medical costs.
The study comes as the federal government plans to provide up to $27 billion in incentives through the meaningful use program to encourage health care providers to transition to EHRs, in the hope that the technology will help rein in health care spending.
Proponents of EHRs have said that they help reduce unnecessary and duplicative testing by providing physicians with better and more up-to-date information when treating patients. However, Danny McCormick, lead author of the study, said the research “raises real concerns about whether health information technology is going to be the answer to reducing costs.”
What the researchers suggest: Researchers found that physicians with electronic access to patients’ previous imaging results ordered tests 40% more frequently than those using paper records. Doctors with EHRs ordered tests on 18% of visits, compared with 12.9% for physicians who used paper records. The study also found doctors with EHRs ordered more advanced and costly imaging, such as MRI tests and CT scans, 70% more frequently than those with paper records.
Although the study did not explore the reasons physicians who use EHRs order more tests, the researchers said the technology could make ordering tests easier. McCormick said, “As with many other things, if you make things easier to do, people will do them more often.”
What health policy experts say: Many health policy experts were critical of the study’s methods, noting that the survey data predate the meaningful use incentive program and standards that launched last year. Michael Furukawa, a health economist in the Office of the National Coordinator for Health IT, said the focus of the study was limited. “The proper use of advanced health IT functions, we believe, will reduce costs in the long run,” he said.
David Blumenthal, former National Coordinator for Health IT, also noted that the study is among a “small minority of studies” that have doubted the value of health IT. Likewise, David Brailer, National Coordinator for Health IT under President George W. Bush, questioned the conclusions because they were based on a correlation in the data rather than as a result of a controlled trial.
Our take: Of course these health policy experts who have their careers and reputations on the line are going to continue to push for adoption of electronic health records. If the study’s findings are true, the transition to EHRs will be a huge waste of money and time for the government and the health care industry, which could prove embarrassing for all parties who pushed for it. That being said, it is not surprising that ONC would be quick to punch holes in the study to try to discredit the findings. The responses are telling, also, in that most of their arguments are about the study’s methods, rather than its findings. The study carries an important lesson, regardless of whether its findings are true: it is prudent to continually evaluate the success of initiatives as they are being implemented, particularly if the initiative carries multibillion dollar price tag.
by Lindsey Underwood, staff writer