Health Records Spat Flares Anew

A skirmish over the efficacy of electronic health records to reduce health-care costs is escalating into a full-scale war of words.

At the center of the controversy is an article that appeared in the March issue of Health Affairs: "Giving Office-Based Physicians Electronic Access to Patients' Prior Imaging and Lab Results Did Not Deter Ordering of Tests." Using 2008 data, the authors determined that doctors with on-site access to computerized imaging results were 40 percent to 70 percent more likely to order imaging tests such as X-rays. Previous studies showed that health IT reduced the number of medical tests ordered, especially duplicate tests.

The national coordinator for health IT, Dr. Farzad Mostashari, challenged the findings in a March 6 post to his office's Health IT Buzz blog. The researchers' conclusions overshot the evidence, Mostashari charged.

"Seemingly surprising headlines can be tempting, but it's important to get the facts," he wrote. "The evidence shows we are on the right track to establishing the health IT foundations for a true 21st century U.S. health system where patients get better care, while we reduce health care costs."

The authors -- Danny McCormick, David Bor, Stephanie Woolhandler and David Himmelstein -- fired back a few days later, saying Mostashari was mistaken in some of his assertions, some of which "reflect wishful thinking regarding health IT; an acceptance of deeply flawed evidence of its benefit, and skepticism about solid data that leads to unwelcome conclusions."

In a point-by-point rebuttal of Mostashari's critique, the authors contend that EHR vendors have not yet produced the kind of game-changing advancements that would nullify findings based on 2008 data.

"No drug or new medical device could pass FDA review based on such thin evidence as we have on health IT," they write. "Yet (ONC) is disbursing $19 billion in federal funds to stimulate the adoption of this inadequately evaluated technology.

"Dr. Mostashari is perhaps the only person in our nation who commands the resources needed to mount a well done randomized controlled trial to fairly assess the impact of health IT, and the comparative efficacy of the various EHR options," they concluded.