Authors noted that policy-based incentives for providers to adopt health information technologies, including the HITECH Act’s electronic health records meaningful use program, “are predicated on the assumption that, among other things, electronic access to patient test results and medical records will reduce diagnostic testing and save money.”
However, the study used 2008 data on 28,741 patient visits to 1,187 office-based physicians to conclude that electronic accessibility to test results was associated with more tests ordered, and, “The availability of an electronic health record in itself had no apparent impact on ordering: the electronic access to test results appears to have been the key.”
Consequently, the meaningful use program may not yield anticipated savings from fewer duplicative testing and may drive up costs, authors concluded.
But the data used to reach these conclusions was collected one year before HITECH was enacted and three years before Stage 1 of meaningful use began, at a time when far fewer physicians were using EHRs with less functionality, compared with today.
Mostashari, in a new blog posting, highlights the report’s conclusion that EHRs by themselves were not associated with increased testing and contends the study tells little about the ability of EHRs to reduce costs, and says nothing about the impact of EHRs to improve care.
“Moreover, the authors did not consider clinical decision support, which helps give providers the data tools they need to make appropriate care recommendations and the ability to exchange information electronically,” Mostashari writes. “These are two of the most critical features of certified EHRs, which have been shown in multiple well-designed studies to reduce unnecessary and duplicative tests.”
He also asserts the study looked at the quantity of tests without regard to whether more tests were medically necessary. “As both patients and providers well know, an appropriate follow-up for a suspicious nodule is a test you want to have.” He concludes: “Seemingly surprising headlines can be tempting, but it’s important to get the facts.”
Mostashari’s blog is here and the report, “Giving Office-Based Physicians Electronic Access to Patients’ Prior Imaging and Lab Results Did Not Deter Ordering of Tests,” is available for purchase here.
In both New Zealand and Australia there is 97% GP EMR uptake and universal information exchange. We can see clear-cut benefits with better linkages between primary and secondary care,faster and more efficient patient transfers and higher levels of physician satisfaction (See Commonwealth Fund surveys) and a host of other incremental improvements that have contributed to making our health systems some of the most efficient in the world.
With respect to improving efficiency of diagnostic test ordering we are using technology to coach requesters to be more efficient and enabling them to immediately identify if the test they want has already been performed recently and delivering it to them. Our ordering patterns and usage is steadily becoming more and more efficient.
Dr Mostashari you are doing a great job and you are headed in exactly the right direction. Please don't take your foot off the accelerator.
Tom Bowden CEO HealthLink Ltd, (Auckland, Sydney, Brisbane, Perth, Melbourne and Vancouver).
If the authors really wanted to demonstrate the impact of EHR adoption on physician imaging and test ordering they would have had to compare the ordering habits for the SAME docs before and after EHR adoption- or to otherwise create a real control group and do a real test. Dr Brailer quoted in the related WSJ review of the study referenced the same flaw when he stated that he was unconvinced by the study's conclusions because they were based on a correlation in the data and were not the result of a controlled test.
EHRs may have an impact on imaging and other clinical test ordering. The referenced study doesn't seem to shed any meaningful light on the topic