Dr. Danny McCormick of Cambridge Health Alliance and colleagues faced heavy criticism last week when they published a study saying that electronic health records may not be the panacea for skyrocketing costs that many have hoped for. Dr. Farzad Mostashari, the national coordinator for health information technology, posted a blog criticizing the study as too narrow and outdated, saying it “tells us little” about the systems’ ability to save money.
McCormick and his co-authors posted a reply to Mostashari on the Health Affairs website today, saying some of the assertions Mostashari makes are “mistaken.”
“Some take us to task for claims we never made, or for studying only some of the myriad issues relevant to medical computing,” they wrote. “And many reflect wishful thinking regarding health IT; an acceptance of deeply flawed evidence of its benefit, and skepticism about solid data that leads to unwelcome conclusions.”
The authors looked at surveys completed by doctors after 28,741 patient visits in 2008. After using statistical methods to adjust the data for variations between physician practices, they found that those doctors who had electronic access to imaging results were at least 40 percent more likely to order tests than those who had no electronic access to results.
The study was met with a chorus of criticism, including comments from Mostashari saying the data were outdated because systems have come a long way since 2008. He said modern systems include “decision support” components that help providers decide when a particular test is necessary.
Here’s more of the response from McCormick and his co-authors, David Bor, Stephanie Woolhandler, and David Himmelstein. See the full reply on the Health Affairs blog:
We focused on electronic access to results because the common understanding of how health IT might decrease test ordering is that it would facilitate retrieval of previous results, avoiding duplicate tests. Indeed, it’s clear from the extensive press coverage that our study was seen as contravening this “conventional wisdom”.
Nonetheless, Dr. Mostashari criticizes us for analyzing the impact of physicians’ electronic access to imaging and test results, but not other aspects of electronic health record (EHR) use. We did, however, analyze the relationship of EHRs to test ordering in a subsidiary analysis. While physicians use of a full EHR was associated with a 19% increase in image ordering, as we noted in the paper this finding was not statistically significant. While we cautiously (and properly) interpreted this as a “null” finding, these data are inconsistent with Mostashari’s optimistic view that use of a full EHR reduces costs.
He asserts that our 2008 data are passe, and that health IT meeting today’s “meaningful use” criteria definitely saves money. The data we analyzed were the latest available data when we initiated the study. While the proportion of outpatient physicians utilizing health IT has grown since 2008, we are unaware of any “game changing” health IT developments in the past four years that are would produce substantially different results if the study were repeated today. The EHR vendors that dominated the market in 2008 remain, by and large, today’s market leaders, and their products have undergone mostly modest tweaks. Mostashari’s contention that 2012 EHRs – incorporating decision support and electronic information exchange – save money in ways not possible in 2008 should be tested through additional research but remains merely a hypothesis. We hope that some day his predicted savings can be achieved.