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Do electronic records really save money?

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Uh oh.

Even though researchers at Indianapolis-based Regenstrief Institute Inc. demonstrated more than 20 years ago that electronic health records and test ordering systems significantly reduced costs in Indianapolis’ Wishard Health Services’ system, a recent study of electronic health records among office-based physicians came to the opposite conclusion.

The study, published in the journal Health Affairs, casts a bit of doubt on one of the main arguments for the rapid expansion of health information technology, which received a $30 billion boost from the 2009 stimulus act.

Having computerized health records made physicians 40 percent to 70 percent more likely to order imaging tests, according to the Health Affairs study, after the researchers adjusted for other kinds of differences among the 1,187 physicians and 28,741 patients visits analyzed in the study.

That flies counter to the conclusions of Regenstrief and Wishard researchers, which have found repeatedly that having electronic access to recent imaging test results eliminated duplicative testing, thus reducing costs.

In comments to the Wall Street Journal Health Blog, study author Danny McCormick said the Health Affairs study does not explain why office-based physicians using electronic medical records order imaging tests more frequently. But his team speculates that electronic medical record systems, by making it more convenient to receive imaging test results, may influence doctors to order them more frequently.

“If [doctors know] that the image result will show up on the screen with no questions and no problems, it may subtly influence them to order” the test, said McCormick, an assistant professor at Harvard Medical School.

The study authors note that their analysis says nothing about whether electronic health records can improve the quality of care—another argument frequently made in favor of their adoption.

“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,” the study authors wrote. “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.”

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  • Costs vs. revenues
    I suspect that the underlying difference in the results for Wishard Hospital as opposed to private physicians has less to do with electronic medical records, and more to do with the motivation behind their use.

    Wishard's compensation for service encourages frugal use of resources. Physicians on the other hand are still compensated primarily based upon the number of procedures completed.

    Market forces and the profit motive contribute to higher healthcare costs. Until the compensation and reimbursement system is based upon health outcomes, instead of the number of billable units performed, healthcare costs will continue to outpace the overall economy

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