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Will electronic medical records really save money? UPDATED

March 6, 2012

Research published in Health Affairs indicates electronic medical records might save less money than some supporters suggest, at least in terms of limiting the number of tests doctors order for their patients.

The study, conducted by members of the Cambridge Health Alliance and the CUNY School of Public Health, analyzed nearly 30,000 patient visits to more than 1,000 different physicians. The doctors who had access to “computerized imaging results” (x-rays, bone density measurements, ultrasounds, etc…) were 40% to 70% more likely to order another imaging test. Access to electronic copies of lab tests also increased the likelihood of more blood tests.

That’s bad news for advocates, who believe electronic medical records could prevent doctors from ordering expensive unnecessary tests.  The authors conclude-

These findings raise the possibility that, as currently implemented, 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. We conclude 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.

How could this be? Why, when doctors have access to the information they need, do they feel compelled to get more?  The authors guess it might have something to do with convenience.

In borderline situations, substituting a few keystrokes for the sometimes time-consuming task of tracking down results from an imaging facility may tip the balance in favor of ordering a test. This “convenience” effect of computerized access might cancel out the potential decreases in ordering due to reductions in duplicate or unnecessary testing.

So in cases when doctors aren’t sure if they need another test, electronic medical records might make it easy to order another one “just in case.” Before, the onerous process of tracking down a hard copy might have discouraged docs from bothering.

But that’s just a theory. The researchers admit that other factors or multiple factors might be at play here. Either way, they say their results are a warning to anyone assuming massive cost savings from limited data-

History urges caution in assuming that advances in medical technology will result in cost savings. In fact, the opposite is more often the case.

Rhode Island is a leader in the field of health information technology, thanks in large part to the work of the Rhode Island Quality Institute. I asked the folks over there what they thought of the study. Stay tuned for their response.   Here is a statement from Laura Adams- the CEO of the Quality Institute-

While I would prefer not to comment on the results of each individual study, I can tell you that the support for and use of electronic health records in Rhode Island continues to grow.

Participation in our heath information exchange, currentcare, also continues to grow.  We are nearing key enrollment milestones with several hospitals in the state, such as Care New England, South County and Memorial as well as the Providence Community Health Centers, Thundermist and a number of physician groups.

By the end of this year we plan to have all 13 Rhode Island hospitals connected to currentcare along with 90% of RI prescription data from retail pharmacies, more than 35% of Rhode Islanders enrolled and 400 hospitals physician offices, long term care facilities and visiting nurse agencies as enrollment partners.

We continue to encourage providers, consumers and employers to be part of the healthcare solution.  The more involvement we have in this program the greater savings we all can achieve for the healthcare system and its consumers in this state.  The Rhode Island Quality Institute continues to strive to be a model locally for the rest of the nation to follow.

In the meantime, read the New York Times article on this study.

One Comment leave one →
  1. Phil Anderson permalink
    March 7, 2012 4:27 pm

    The potential cost savings are huge. Have you been to a doctor’s office and seen how many clerical staff are required to maintain records now? No doctor can remember all that paper. Insurance companies process huge amounts of paper, and they get paid to do it. If nothing else, the paper records are dangerous at worst and always costly. Limiting your study to tests only addresses a small piece of the costly inefficiency. Of course getting rid of fee for service medicine would stop the perverse incentive now built in, which requires doctors to do more diagnostic tests as well as procedures in order to financially maintain a practice. Things like currentcare are a good start. The goal should be regional and national medical records. Then you will start to see real cost savings.

    Read the Affordable Care Act, it really starts to address some key issues which will address the cost of delivery, which is where the spiralling costs begin.

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