Farzad Mostashari, national coordinator for health information technology, is taking issue with a new study in the March issue of Health Affairs that concludes having electronic access to medical imaging and lab test results increases the ordering of additional tests.
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.
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