Following a rebuke from Farzad Mostashari, M.D., national coordinator for health information technology, of a recent study concluding that electronic access to imaging and lab test results increases the ordering of additional tests, the study’s authors have fired back.
The study in the March issue of Health Affairs noted that policy-based incentives for providers to adopt HIT, including the 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.”
Mostashari countered that the 2008 data used in the study was dated, the study itself concluded that EHRs by themselves were not associated with increased testing, and that authors failed to note the ability of EHRs to reduce costs and improve care. Further, meaningful use-certified EHRs have decision support capabilities that have been shown in studies to reduce unnecessary and duplicative testing, he contended.
Now, the study authors in a rebuttal published by Health Affairs say some of Mostashari’s assertions are mistaken, while others “take us to task for claims we never made, or for studying only some of the myriad issues relevant to medical computing.”
The authors say the 2008 data they analyzed was the latest available data when the study was initiated. “While the proportion of outpatient physicians utilizing health I.T. has grown since 2008, we are unaware of any ‘game changing’ health I.T. developments in the past four years that would produce substantially different results if the study were repeated today,” the rebuttal states. “The EHR vendors that dominated the market in 2008 remain, by and large, today’s market leaders, and their products have undergone mostly modest tweaks. Mostashari’s contention that 2012 EHRs--incorporating decision support and electronic information exchange--save money in ways not possible in 2008 should be tested through additional research but remains merely a hypothesis. We hope that some day his predicted savings can be achieved.”
Further, the authors contend, Mostashari in his critique cited a paper his own agency authored that had claims of benefits “without regard to study quality or statistical niceties.” They take ONC to task for spending billions of dollars to stimulate adoption of inadequately evaluated technology. “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 end the rebuttal with a parting shot: “Finally, Dr. Mostashari’s unbridled faith in technology is mirrored by his belief that ACOs are the next panacea for health costs and quality. That health policy flavor-of-the-month also remains wholly unproven.”
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