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Health IT Chief Disputes Study On EHR Testing, Costs

By Jenny Gold

March 7th, 2012, 12:09 PM

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.

Farzad Mostashari is the national coordinator for health information technology.

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.”

5 Responses to “Health IT Chief Disputes Study On EHR Testing, Costs”

  1. I could not agree more with Dr. Mostashari’s assessment and statement. If Dr. McCormick truly believes his comment he should offer to withdraw the publication and restate the conclusion, including the title which is grossly misleading of what his data supports.

  2. Lew Sandy MD says:

    I strongly concur with Dr. Mostashari and Dr. Lagrew. Having read the actual Health Affairs paper, I believe the media is widely (and wildly) over/misinterpreting the findings.

    While it is clearly important to assess the real-world impact of HIT on quality, safety, access and costs, the actual study was a cross-sectional analysis of association, so one need to be deeply skeptical of making any causal inferences.

  3. Mitch says:

    It’s amazing the studies some organization will come up with just to protect cheapskate providers that are too “thrifty” to spend some money and improve the lives of their patients. Patients need to vote with their feet and find providers that embrace HIT and aren’t deathly afraid of computers and afraid of progress. Regretfully, we still have Neanderthals in our health care industry.

  4. The findings of the study by Danny McCormack and his colleagues were quite specific: “Physicians’ access to computerized imaging results (sometimes, but not necessarily, through an electronic health record) was associated with a 40–70 percent greater likelihood of an imaging test being ordered.”

    The perspectives and limitations were thoroughly discussed in their report. Although this finding does not fit neatly into the administration’s agenda for information technology (IT) and electronic health records (EHRs), it does not warrant being discredited simply based on what was not studied. Their findings are entirely valid and add another important piece to the puzzle of IT.

    Regarding health care costs, IT and EHRs have been sold to us as being an important tool for reducing health care spending in the future. There is very little evidence of that, and this study tends to refute the specific claim that IT will automatically reduce the ordering of tests.

    IT systems and EHRs are expensive to install and expensive to maintain. Advances in IT technology will inevitably involve expensive upgrades. Physicians’ interactions with EHRs consume time, adding further to the costs of professional manpower. Although there may be some limited cost saving benefits, there is no solid evidence that these savings will offset the increased costs. (That is not to say that the other benefits of computerization are not worth these extra costs; they very likely are.)

    A recent CBO report demonstrated that some of the other proposals to control costs have not been effective in trial programs. We are not seriously addressing the cost issue.

    Single payer and health service models of health care financing have been proven to be much more effective in controlling spending than models which build on our current fragmented system of a multitude of private and public plans (i.e, ACA).

    We’ve been looking in the wrong places to find relief from our burdensome health care spending. It’s time to quit wishing that these other measures would work, and to finally take a serious look at the proven model of single payer.

  5. As an independent solution provider this is a bit shocking to me. Biggest benefit is to avoid carrying the medical records in printed form. Also incase of emergency the biometric information can help in retrieving the medical data of the past which otherwise is suspect. Why are the doctors seeking for additional tests? Have the meaningful integration with the order management systems not prevented such additional orders? May be this could be a change management process and would settle down when the doctors start utilising the sytem efficiently.

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