“Doctors using computers to track tests, like X-rays and magnetic resonance imaging, ordered far more tests than doctors relying on paper records,” reports the New York Times on the findings of a controversial new Health Affairs study.
The study’s authors write that “physicians’ access to computerized imaging results (sometimes, but not necessarily, through an electronic health record) was associated with a 40–70 percent greater likelihood of an imaging test being ordered,” suggesting to them that “electronic access does not decrease test ordering in the office setting and may even increase it, possibly because of system features that are enticements to ordering.” From this, they go on to make the sweeping conclusion that:
“Use of these health information technologies, whatever their other benefits, remains unproven as an effective cost-control strategy with respect to reducing the ordering of unnecessary tests.”
Not so fast, says Dr. Farzad Mostashari, the National Coordinator for Health Information Technology, who issued a response to the Health Affairs article, taking issue with its methodologies and conclusions, which in turn invited a response to his response from the study’s authors. You can read an excellent account of the back-and-forth on this in an American EHR blog post by my ACP colleague, Dr. Michael Barr.
I don’t claim to be an expert on health information technology or on the methodological debate over the Health Affairs research, but my sense is that the study raises an important question—do health information technologies that make it easier to order and then read the results electronically also make it more likely that an unnecessary test will be ordered? I don’t think we definitively know.
But at the same time, there are enough questions about the study and its limitations to reach any sweeping conclusion on the value of health information technologies in reducing costs. Plus, as Dr. Barr points out in his blog post, the world of health information technology is changing rapidly, including the new stage 2 “meaningful use” proposed rules that will encourage adoption of clinical decision support tools, based on evidence-based guidelines on appropriateness, in computerized order entry systems.
Of greater significance than this one study alone is that it adds to a growing body of research and opinion (exaggerated and magnified by news reports and the blogosphere) that suggest that some of the most popular remedies offered to bring down rising health care costs won’t work. Last week, I blogged about the limitations of price competition, transparency, high deductible HSAs, and private contracting in bringing down costs; today, it is heath information technology that at least this one study says won’t deliver the bang for the buck. And my next post will be about studies that raise questions about the value of care coordination in lowering overall spending.
My concern is that the message that could be received by the public and policymakers is that nothing being contemplated today will be effective in bringing down health care costs. So why bother trying? Or let’s just pull the plug on the ones that aren’t working?
Healthy skepticism about the cost control idea of the day is good. More research is good. But at some point, showing the limitations of current cost control interventions and suggesting more studies won’t be enough. Instead, we will have to come up with an American way that will actually work to lower health care costs, or policymakers will end up on the tried and true cost control measures used in other countries: explicit rationing of services, and even more price and capacity controls.
Today’s question: What do you think about the research questioning the value of health information technology in lowering costs?