A study published in the journal Health Affairs this week found that doctors who use electronic health records may order more diagnostic testing, and therefore drive up the cost of health care, despite claims to the contrary by the federal government and health IT industry.
Now, Dr. Farzad Mostashari, national coordinator for health information technology, is pushing back.
In a post on the ONC’s HealthITBuzz blog, Mostashari wrote a point-by-point take-down of the Health Affairs study. The post, as first reported by Politico Pro, argues that the study “tells us little about the ability of electronic health records (EHRs) to reduce costs” and “nothing about the impact of EHRs on improving care.”
The study’s conclusions, Mostashari writes, were based on electronic viewing of imaging results, rather than EHRs, and the authors did not consider electronic tools that help doctors make clinical decisions about whether or not to use a certain test, or the ability to exchange information electronically. The study’s authors also did not look at whether the additional tests ordered were medically necessary and may have actually improved the quality of care, reducing costs in the long term. “This study focused on the numbers, while ignoring the patient,” he writes.
The Health Affairs study concluded that “the federal government’s ongoing, multibillion-dollar effort to promote the adoption of health information technology may not yield anticipated cost savings from reductions in duplicative diagnostic testing. Indeed, it is possible that computerization will drive costs in this area up, not down.”
But in a phone interview with Kaiser Health News on Monday, lead study author Danny McCormick, assistant professor of medicine at Harvard Medical School, said that the study “is not a criticism of HIT.” As a primary care doctor who had made the switch to electronic records, he said, “I myself would never go back to paper records.”
The study was not about quality or overall utility, he said, but may influence how health IT is adopted. “Do we need to look more carefully and ensure that the long list of things that has to go right to realize these savings are happening?”
The study, McCormick argued, should at least “prompt us perhaps to look elsewhere for answers to the cost crisis plaguing the U.S. health care system.”