A report in the journal "Health Affairs" associates using computerized systems with doctors ordering more lab tests, despite the widespread belief that technology reduces them.
As the health care industry
pushes forward with the adoption of electronic health records, a new study
links higher spending on lab tests with doctors viewing images electronically,
either in image-viewing systems or full EHRs.
, called "Giving
Office-Based Physicians Electronic Access To Patients' Prior Imaging And Lab
Results Did Not Deter Ordering Of Tests," was published in the March 2012
issue of the journal Health Affairs
It concludes that using
health care technology will not prevent doctors from ordering unnecessary lab
tests, despite a widely held belief that using tools such as EHRs will reduce
the amount of diagnostic tests and lower costs in health care.
"We found no evidence
that office-based physicians with electronic access to imaging or blood test
results order fewer imaging tests or blood tests, respectively," the
report stated. "Indeed, at least for imaging, the reverse may be true:
Facilitating physicians' access to test results through computerization may
increase diagnostic image ordering."
The lead author was Dr.
Danny McCormick, an assistant professor of medicine at Harvard Medical School
and a director in the department of medicine at the Cambridge Health Alliance
, a health care system north
The study examined data from
the National Center for Health Statistics' National Ambulatory Medical Care
Survey. The data comprised 28,741 patient health records from visits to 1,187
doctors in 2008. Researchers compiled the data before the Obama
administration's incentive program for "meaningful use" of EHRs began
In the study, when doctors
used various types of computing technology, they ordered between 40 percent and
70 percent more lab tests such as X-rays than when they ordered using paper
Data was used to assess how
many lab tests doctors ordered when the data was originally intended to study
how medical care was practiced, The New York Times
reported March 5.
However, not everyone agrees
with the report's findings.
interpretations may make for attention-getting headlines, it's important to get
the facts," Dr. Farzad Mostashari, the national coordinator for health IT,
wrote in a March 6 blog post
. "There are several
reasons McCormick's study ultimately tells us little about the ability of
electronic health records to reduce costs, and why it tells us nothing about the
impact of EHRs on improving care."
David Whitlinger, executive
director of the New York eHealth
(NYeC), agreed with Dr. David J. Brailer, the national coordinator for health
IT under President George W. Bush, who told The
that there was no control in the study.
"That's not a good way
to try to measure what's being reported," Whitlinger told eWEEK
. NYeC is a nonprofit organization
that sets the policies and standards for EHRs in New York State and operates
the state's health information exchange (HIE).
Harvard's McCormick did not
respond to eWEEK
's request for
"It's a somewhat
surprising finding," McCormick told CNN.com
. "Health IT is often
put forward as a major solution to the cost crisis affecting the health care
system. If it actually is not likely to decrease costs, we probably ought to
know about that early on."
Although use of EHRs showed
no association in itself with test ordering, some subjects in the study used
EHRs with image-viewing capabilites. The viewing of images was associated with
ordering more tests.
McCormick told the Times
that he intends to stick with EHRs
despite the report's findings.
"History urges caution
in assuming that advances in medical technology will result in cost
savings," the Health Affairs report stated. "In fact, the opposite is
more often the case."
Although doctors that viewed
images electronically ordered more images, the study doesn't conclusively prove
that one caused the other, according to Erica Drazen, managing director for the
Global Institute for Emerging Healthcare Practices at CSC.
"The research was only
about looking at the association between being able to view images and whether
[physicians] ordered a lot of imaging tests," Drazen told eWEEK
Drazen agreed with
Mostashari's assessment that ordering more lab tests may lead to buying
additional equipment to view the results rather than the technology leading to
additional ordering of tests.
"I come down on the
side of it's more likely that the reason they bought this equipment was because
they were ordering a lot of tests and wanted that capability," she said.