Health IT Study Draws Fire

A study challenging the assumption that health IT reduces unnecessary medical tests is drawing criticism from several fronts, including from the national coordinator for health IT.

The title of the article, published Monday by the journal Health Affairs, summarized the disputed findings: "Giving Office-Based Physicians Electronic Access to Patients' Prior Imaging and Lab Results Did Not Deter Ordering of Tests."

Using data from the 2008 National Ambulatory Medical Care Survey, researchers from the Cambridge Health Alliance and City University of New York found that physicians with point-of-care electronic access to imaging results were 40 percent to 70 percent more likely to order X-rays and other imaging tests than other doctors. They suggested that easy access to the images prompted physicians to order more imaging studies.

While the findings raised eyebrows in the health IT world, what really got health IT czar Dr. Farzad Mostashari riled up was the researchers' statement 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."

The study "ultimately tells us little about the ability of electronic health records to reduce costs, and ... nothing about the impact of EHRs on improving care," Mostashari wrote in the ONC's Health IT Buzz blog.

The researchers found no link between the use of EHRs and test ordering, he wrote, and used data gathered before the government offered incentives to encourage the purchase of EHRs with key functionality, such as clinical decision support. He added that the researchers did not examine whether the doctors had access to electronic clinical decision support, which provides advice on test and treatment options.

Erica Drazen, managing director of the Global Institute for Emerging Healthcare Practices at CSC, a Falls Church, Va.-based IT services and consulting firm, made similar arguments in a statement provided to NextGov.

"Isn't it likely that physicians who order many imaging tests would invest in systems to view images and results?" Drazen asked. "This seems a much more likely explanation than the authors' primary theory that knowing that you can view results electronically motivates physicians to order more tests."

She noted that several controlled trials have demonstrated that doctors order fewer tests -- and fewer duplicate tests -- when their health IT systems include prior test results and make suggestions on whether to order more tests.

"Before concluding that computer systems won't improve the appropriate use of imaging tests -- based only on a correlation between the capability to view results and ordering rates -- we should remember that well-designed trials (and common sense) lead to the opposite conclusion," Drazen wrote.