A recovering policy wonk, I still enjoy a good old-fashioned debate on the effectiveness of public policy. And we seem to have one going this week. As you may have seen, a study in the March issue of Health Affairs calls into question the widely held assumption that health IT will reduce duplicative testing and lower health care costs. The researchers, led by Danny McCormick from the Harvard Medical School, claim that doctors with computerized access to imaging and lab results are actually more likely — 40 to 70 percent more likely — to order tests than non-digitized docs.
"The results suggest that the federal government's ongoing, multibillion-dollar effort to promote the adoption of health information technology may not yield anticipated cost savings from reductions in duplicative testing. Indeed, it is possible that computerization will drive costs in this area up, not down," they wrote.
The article set off a bit of a firestorm, especially at the Office of the National Coordinator. In a blog yesterday, ONC chief Farzad Mostashari, M.D., wrote, "While such interpretations may make for attention-getting media headlines, it's important to get the facts. There are several reasons why McCormick's study ultimately tells us little about the ability of electronic health records to reduce costs, and why it tells us nothing about the impact of EHRs on improving care." But Mostashari wasn't done. He reportedly continued to blast the study during his opening remarks before the federal Health IT Policy Committee.
Mostashari wasn't the only one questioning the study's legitimacy. Doctors David Brailer and David Blumenthal — the first two heads of ONC — were both quoted in the New York Times, saying that the study missed the mark. And, Erica Drazen, managing director of consultancy CSC's Global Institute for Emerging Healthcare Practices, sent me an email saying: "This type of research only shows an association between two factors — it cannot be used to reach conclusions about what causes this association. So, while it does show that physicians who order many tests also have electronic access to view results, we can't conclude that having electronic access to results causes them to order tests. Instead, it is more likely that because they order many tests, these physicians chose to purchase capabilities to view the results. The title of the Health Affairs study — 'Giving Office-Based Physicians Electronic Access to Patients' Prior Imaging and Lab Results Did Not Deter Ordering of Tests' — is a little misleading. You might assume that this study compared ordering rates before and after a group had electronic access to results. It did not — it looked at one point in time after the provider had access to test results."
Watching this debate unfold during the past couple of days, Mostashari raised a couple of salient points: the study didn't consider clinical decision support, which many believe will help providers make appropriate care decisions, nor did the study assess the ability of providers to exchange data. But it's also worth pointing out that robust health information exchange is in its infancy. Interoperability between technology systems, let alone providers, is still a work in progress. So, is it any wonder that doctors continue to order tests when they can't get results from other providers? I'm probably not alone in experiencing this kind of redundancy. I recently switched primary care doctors and he wants to order a whole new set of scans on my lower back, which has been a constant source of pain. This despite the fact that my previous doctor ordered scans two years ago and very little has changed in my overall health. Both run independent practices, but are affiliated with the same, large, Most Wired Chicago hospital.
McCormick and his colleagues acknowledge that they didn't study what caused digital docs to order more tests. And they also note that the findings differ from other studies. But, they offer up this conclusion: "Whatever the explanation for our findings, they emphasize the importance of establishing the benefits of computerization rather than estimating them in the absence of data, or generalizing from small studies at a few atypical institutions."
Given the amount of money that the government, providers and vendors are pouring into adoption, this hardly will be the last policy debate on the benefits of health IT.
Matthew Weinstock is senior editor of H&HN. You can reach him at firstname.lastname@example.org.