Health Care Technology Could Increase Spending on Lab Tests: Study

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.

The report, 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 of Boston.

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 2009.

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 records.

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.

"While such 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 Collaborative (NYeC), agreed with Dr. David J. Brailer, the national coordinator for health IT under President George W. Bush, who told The Times 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 additional comment.

"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.