A recent study suggesting use of health information technology increases the ordering of tests spurred debate among study authors and National HIT Coordinator Farzad Mostashari, with HDM readers then weighing in. Here’s a sampling of reader comment:
From John W: “HIT enhances knowledge. Knowledge is good. Nuff said.”
From Casey Q: “What John said. Plus, drawing conclusions based on information not fully relevant to the issue doesn't create actionable results. I'm still on Mostashari's team.”
From Robert D: “I couldn't agree more with the authors of the study. The medical industry's newfound love affair with technology has yielded a touching yet naive understanding of what the technology is capable of doing without at the same time producing an understanding of what it cannot do. At the heart of the embrace of technology, chiefly by technologists and not necessarily by the physicians themselves, is a belief that humans are hampered by their tools and that given the right tools, humans will be good and will behave like the good citizens of the world that they believe they are.
“That perception of the world does not match the way that people actually behave. Will doctors order more tests or fewer tests if they have more data? I think they will order more, only because the patient will have morphed from a person to a data record. A byte here, a byte there, what's the difference if another test is ordered that could confirm what is still slightly unclear?
“For the presumed leader of the national IT initiative to lambaste the authors of the article for daring to speak heresy is hardly the hallmark of leadership. It is the hallmark of personal umbrage and smacks of vindictiveness. Why not simply look at the data and determine if the authors are reasonable to conclude what they have concluded? If we are all supposed to be on the side of creating a better provision of health care services for the general population, I would think that an open mind, regardless of how far down the path we have already traveled, is the appropriate response, not castigation for having the hubris to question the underlying assumptions of what is becoming increasingly clear to be another new bureaucracy that is as unyielding and inflexible as anything else that Washington has already produced.”
From Ed F: “A few thoughts: With all due respect to the authors of the study, the study seems to demonstrate that MDs who liked technology enough to use an EHR in 2008 (i.e. well prior to federal incentives and uptake by 'average' MDs) ordered more technology-based tests... WOW! And the suggestion that EHRs make test-ordering easier is pretty fanciful. In 10+ years of clinical practice I ordered thousands of tests by simply checking a box or asking a nurse to get the test ordered--I’m not sure how much easier it can get. And as a final cause and effect exercise, let's consider that in 2008 most MD EHR users were employees of the entity being paid to perform the tests ordered. Hmmm...
“Also, with the assertion that, "Dr. Mostashari is perhaps the only person in our nation who commands the resources needed to mount a well done randomized controlled trial to fairly assess the impact of health I.T., and the comparative efficacy of the various EHR options," the authors might take a closer look at ONC vs. other HHS Health I.T.-related funding. Most of the funding for Health I.T. goes to CMS, not ONC. And research on Health I.T. (and most other health care-related issues) is funded and led by AHRQ.
“To the point of others commenting on this study:
“1. EHRs may impact the amount of tests ordered by the average MD. This study sheds little relevant light on that matter.
“2. EHRs have the potential to provide substantially more benefits than reducing image test ordering. As a pilot I can tell you that my avionic technology has not increased or decreased the frequency of my flights- but they're a heck of a lot safer.”
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