Study: E-Health Records Don’t Deter Testing, Spending

Electronic health records have long been touted by Democrats and Republicans alike as a sure-fire way to lower health spending. When doctors have easy electronic access to a patient’s records, advocates argue, they are less likely to order the duplicative and unnecessary tests that drive up the cost of health care in America.

But that assertion is not necessarily proving to be true. Doctors who use EHRs may actually order more diagnostic testing, and therefore make health care even more expensive, according to a study published in the the journal Health Affairs.

Researchers found that office-based physicians were actually 40 to 70 percent more likely to order an imaging test if they had access to computerized imaging results. The study is based on data from the 2008 National Ambulatory Medical Care Survey of 28,741 patient visits to 1,187 physicians.

EHRs may be yet another example of a health care solution that looks great on paper, but “when you actually try to implement it in real world settings with real patients” it may have some “unintended consequences,” says lead author Danny McCormick, a primary care physician and assistant professor of medicine at Harvard Medical School.

EHRs have been estimated to save $77.8 billion annually, largely by avoiding imaging such as MRIs and lab tests. Doctors can view a patient’s previous tests in real time, and can use this information to determine whether another test is really needed. In addition, software in the EHRs can help a doctor make this decision.

But EHRs also make diagnostic images easier to order and easier to review. Imagine a doctor sitting with a patient, says McCormick. If the doctor orders an MRI on one of these systems, he “knows with certainty the report will show up the next day on [his] computer screen with no hassle. But without a computer record, [he] might have to struggle to get it,” requiring an investment in staff time to request a fax of the study, which may then be difficult to read.

This “convenience effect” may subtly shift the doctor’s incentives, encouraging him to order diagnostic tests more liberally.

While EHRs may still improve health care quality and efficiency, says McCormick, the study results do not bode well for the federal government’s multibillion dollar plan to save money by encouraging doctors to adopt health information technology.

The study “should prompt us perhaps to look elsewhere for answers to the cost crisis plaguing the U.S. health care system,” McCormick adds.

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