Digital Records May Not Cut Health Costs, Study Cautions

New York Times Article March 6, 2012

Computerized patient records are unlikely to cut health care costs and may actually encourage doctors to order expensive tests more often, a study published on Monday (March 3, 2012) concludes.

Industry experts have said that electronic health records could generate huge savings — as much as $80 billion a year, according to a RAND Corporation estimate. The promise of cost savings has been a major justification for billions of dollars in federal spending to encourage doctors to embrace digital health records.

But research published Monday in the journal Health Affairs found that doctors using computers to track tests, like X-rays and magnetic resonance imaging, ordered far more tests than doctors relying on paper records.

The use of costly image-taking tests has increased sharply in recent years. Many experts contend that electronic health records will help reduce unnecessary and duplicate tests by giving doctors more comprehensive and up-to-date information when making diagnoses.

The study showed, however, that doctors with computerized access to a patient’s previous image results ordered tests on 18 percent of the visits, while those without the tracking technology ordered tests on 12.9 percent of visits. That is a 40 percent higher rate of image testing by doctors using electronic technology instead of paper records.

The gap, according to the study, was even greater — a 70 percent higher rate — for more advanced and expensive image tests, including M.R.I. tests and CT, or computerized tomography, scans.

“Our research raises real concerns about whether health information technology is going to be the answer to reducing costs,” said Dr. Danny McCormick, the lead author of the study, who is an assistant professor at the Harvard Medical School and a member of the department of medicine at the Cambridge Health Alliance, a health system north of Boston.

Dr. McCormick had three co-authors: Dr. David H. Bor, chief of medicine at the Cambridge Health Alliance; and Dr. Stephanie Woolhandler and Dr. David U. Himmelstein, both professors at the City University of New York School of Public Health at Hunter College.

The research was based on a survey conducted by the National Center for Health Statistics, which collected data from more than 28,000 patient visits to more than 1,100 doctors in 2008.

Health policy experts who have championed the adoption of electronic health records were critical of the study. They noted that the data came from the National Ambulatory Medical Care Survey, which is intended mainly for another purpose — to assess how medical care is practiced.

The study, they noted, included any kind of computer access to tracking images, no matter how old or isolated the function.

By contrast, modern electronic health records are meant to give doctors an integrated view of a patient’s care, including medical history, treatments, medications and past tests. The 2008 data predates federal incentive payments for doctors and standards for the “meaningful use” of electronic health records that began last year.

The new study, they said, was also at odds with previous research. It is “one of a small minority of studies” that have doubted the value of health information technology, said Dr. David Blumenthal, a professor at the Harvard Medical School.

Dr. Blumenthal, the former national coordinator for health information technology in the Obama administration, was co-author of a study, published last year in Health Affairs, that surveyed articles in professional journals in recent years on electronic health records.

It found that 92 percent of those articles were “positive over all” about the prospect that technology would improve the efficiency and quality of care.

But Dr. McCormick said the previous research had been primarily statistical models of expected savings, like the RAND study, or research that looked at the use of electronic health records at a relatively small number of flagship health systems.

“We looked at not just a few cutting-edge institutions, but a nationally representative sample,” Dr. McCormick said.

Dr. David J. Brailer, who was the national coordinator for health information technology in the administration of George W. Bush, said he was unconvinced by the study’s conclusions because they were based on a correlation in the data and were not the result of a controlled test.

The study did not explore why physicians in computerized offices ordered more tests. Dr. McCormick speculated that digital technology might simply make ordering tests easier.

Dr. McCormick said he hoped the study would damp any inflated expectations about electronic records. But he added that the technology can improve the actual practice of medicine.

The Cambridge Health Alliance, where he practices, made the switch to electronic records in 2005.

“I’m a primary care doctor,” Dr. McCormick said, “and I would never go back.”