Could electronic medical records add costs?
March 5th, 2012
04:01 PM ET

Could electronic medical records add costs?

Electronic streamlining of medical records has been touted as a way to save money, against the backdrop of a health care system that is characterized as wasteful. Electronic medical records (or "Health IT") are supposed to save billions of dollars by eliminating duplicate or unnecessary testing.

But a new study is saying just the opposite: Health IT may actually add cost to health care instead of curbing it.

In fact, the study, just published in the journal Health Affairs, suggests that doctors who had electronic access to patient data were between 40-70% more likely to order tests.

"It's a somewhat surprising finding," said Dr. Danny McCormick, assistant professor of medicine at Harvard Medical School, and study co-author. "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."

McCormick and colleagues analyzed data from the 2008 National Ambulatory Medical Care Survey, which included 28,741 patient visits presided over by 1,187 physicians.

To be included in the analysis, physicians needed the ability to order and receive patient radiological and lab tests electronically; and they had to be able to get back results of tests visually - meaning, if they ordered a CT scan of the abdomen, they could get back an image of that scan on their computer.

The theory behind corralling a patient's medical records electronically – and being able to access previous data – is that it would, among other things, obviate unnecessary tests.

But just the opposite happened in this study.

Physicians who had electronic access ordered tests during 18% of visits, compared with physicians without access, who ordered 12.9% of the time.

"What we think is may be going on is that like in a lot of spheres of human behavior, if you make something easy to do, people will do it more," said McCormick. "We saw a strong association between having the capacity to view an image and ordering more tests."

One reason for the disconnect between this study's findings and those suggesting billions in savings, according to McCormick, is that those studies are based on successfully implemented electronic records systems at large health systems, such as Kaiser Permanente and the Mayo Clinic.

But there are real-world considerations that don't translate the same way they do at those big institutions, according to McCormick.

First, smaller practices may not be using technology as sophisticated as larger health systems. Another theory is that simply ordering up another test might be perceived as easier than taking time to review previous test results.

"The effect may be to provide subtle encouragement to physicians to order more imaging studies," according to the study.

A previous analysis by Harvard researchers, published in 2009 in the American Journal of Medicine, similarly suggests that, in general, hospital computing systems have not reduced overall costs.

This most recent survey was not designed to answer more sophisticated questions, like whether the patient actually needed the test. Or whether doctors who are savvy enough to install electronic medical records systems at their practices might also be more inclined toward ordering tests in borderline cases.

To be sure, more study is needed. And that is the point, according to McCormick.

"It really should give caution to those making the claim that Health IT is going to make a substantial dent in the cost crisis facing the health care system," said McCormick.

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