Physicians who use EHRs order more tests, study finds

Findings suggest e-access may not curb health costs

Physicians who use electronic health records (EHRs) are up to 70% more likely to order an imaging test than other doctors, raising questions about whether the technology will actually reduce medical costs, according to a study in Health Affairs.

The study, conducted by the Cambridge Health Alliance, analyzed data from the 2008 National Ambulatory Medical Care Survey on 28,741 patient visits to 1,187 office-based physicians.

Researchers found that physicians with electronic access to patients' previous imaging results were 40% more likely to order tests than those using paper records. Physicians with EHRs ordered tests on 18% of visits, compared with 12.9% for physicians who used paper records. The study also found physicians with EHR access were 70% more likely to order more advanced and costly imaging—such as MRI tests and CT scans—than those with paper records.

Although the study did not explore why physicians who use EHRs may tend to order more tests, the researchers said the technology could make ordering tests easier. Danny McCormick, lead author of the study, said, "As with many other things, if you make things easier to do, people will do them more often."

Study raises questions about cost savings
The study comes as the federal government plans to provide up to $27 billion in incentives through the meaningful use program to encourage health care providers to transition to EHRs, in the hope that the technology will help rein in health care spending.

Proponents of EHRs have said that they help reduce unnecessary and duplicative testing by providing physicians with better and more up-to-date information when treating patients. However, McCormick said the research "raises real concerns about whether health information technology is going to be the answer to reducing costs."

Experts criticize methodology
Many health policy experts were critical of the study's methods, noting that the survey data predate the meaningful use incentive program and standards that launched last year. Michael Furukawa, a health economist in the Office of the National Coordinator for Health IT, said the focus of the study was limited. "The proper use of advanced health IT functions, we believe, will reduce costs in the long run," he said (Lohr, New York Times, 3/5; Gold, "Capsules," Kaiser Health News, 3/5; McKinney, Modern Healthcare, 3/5 [subscription required]; Sun, Washington Post, 3/5).


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