Study: EHRs Lead to More Tests

Easy electronic access to test results appears to increase the likelihood that doctors will order imaging and lab tests by as much as 70 percent, according to a new study published in the March issue of the journal Health Affairs. The study raises questions about the presumed cost savings of health IT.

Physicians with point-of-care electronic access to imaging results were 40 percent to 70 percent more likely to order an imaging test, researchers from the Cambridge Health Alliance in Boston and City University of New York found. Those with electronic access ordered imaging in 18 percent of visits to physician-based offices, versus 12.9 percent for physicians without access. In some cases, access was available through electronic health records, according to a Health Affairs news release describing the article.

"Our findings should at a minimum raise questions about the whole idea that computerization decreases test ordering and therefore costs in the real world of outpatient practice," says lead author Danny McCormick, a physician and assistant professor of medicine at Harvard Medical School, in the news release. "As with many other things, if you make things easier to do, people will do them more often."

The researchers analyzed data from the 2008 National Ambulatory Medical Care Survey, which includes 28,741 patient visits to a national sample of 1,187 physician-based offices. The survey excluded hospital outpatient departments and offices of radiologists, anesthesiologists, and pathologists, according to the news release.

The research also shows that standard imaging studies were ordered more for women than for men, perhaps because of mammograms and ultrasounds. Specialists including surgeons also were more likely to order imaging than primary-care physicians.

In an interview published in today's Washington Post, Michael Furukawa, a health economist at the Office of the National Coordinator for Health IT, challenged the researchers' conclusions. Good electronic health record systems are likely to recommend doctors forego certain imaging tests deemed unnecessary, he said. The data also don't distinguish between patients requiring acute care and those already being treated, he said.

"The proper use of advanced health IT functions, we believe, will reduce costs in the long run," Furukawa told the Post.

For their part, the researchers say the varying quality of health IT likely affects whether technology can achieve the $8.3 billion in annual savings predicted by some studies.

Current office-based health IT systems may be "cumbersome, insufficiently interoperable, or lack effective decision-support software," the authors contend. They noted their findings held true in hospital-owned practices with better interoperability and decision-support functions than in other practices.