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Electronic Records May Not Lower Health Costs

Electronic Records May Not Lower Health Costs

Convenience and lower costs have been regularly cited as two benefits of electronic health records. But a recent study published in Health Affairs has found that digital medical records may not necessarily cut health costs. Physicians who use such records to track a patient’s x-rays and magnetic resonance imaging actually ordered more tests, says the study, leading to more costs.

According to the New York Times, a RAND study has estimated that using electronic medical records would result in savings of $80 billion. But the Health Affairs study instead found that doctors with access to electronic records ordered tests on 18 percent of the visits; in contrast, those without such technology ordered them on 12.9 percent of visits. That is, there was a 40 percent higher rate of image testing when doctors used electronic technology instead of paper records. Moreover, there was a 70 percent higher rate for tests that were more advanced and expensive, including M.R.I. tests and CT, or computerized tomography, scans.

The lead author of the study is Dr. Danny McCormick, an assistant professor at the Harvard Medical School and also a member of the department of medicine at the Cambridge Health Alliance, a health system in the Boston area. The other two researchers are both professors at the City University of New York School of Public Health at Hunter College. The researchers used data from the National Center for Health Statistics, from more than 28,000 patient visits to more than 1,100 doctors in 2008. Dr. McCormick noted that previous research had relied on what were mostly statistic models of expected savings or on data from a “relatively small number of flagship health systems”; his and his colleagues’ study instead used data from a “nationally representative sample.

Why physicians accessing electronic medical records order more tests was not a question addressed in the study. Dr McCormick noted to the New York Times that a digital system “might simply make ordering tests easier,” while noting that he himself, as a primary care doctor, much prefers the digital technology for medical records.

An analysis of the study on the New York Times Bits blog by Steve Lohr points out that, questions of costs aside, the use of electronic medical records is inevitable and already underway. As Lohr notes, the real issue is really about the role of such records in providing overall savings in health care for Americans. Most experts think that such savings will come from “making sure people with chronic conditions like diabetes and heart disease, manage their conditions, stay healthy and out of hospitals.” As many of these patients are “complex cases” — meaning that they have a number of chronic conditions, see various primary care physicians and specialists and take a series of drugs — electronic records could make it possible for any medical provider who can access the system to see a lot of information in one fell swoop and have a fuller picture of a patient’s medical history and treatment.

Perhaps the issue is that doctors, and patients and health care providers, are all still learning how to use the new system and all the new information that it provides. If patients are getting better medical care, are the costs not worth it?

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6:13PM PDT on Mar 16, 2012

Give it time. As doctors become experienced with the system and more information is available to parse, the real savings will emerge.

6:33PM PDT on Mar 11, 2012

Several times I represented clients who sought their medical records from several years earlier and could not obtain them: The doctor retired and, after a few years, simply threw out the old records; the doctor died, and no one knew what happened to the records; the clinic went bankrupt; there was a fire in the hospital and records were destroyed; the client couldn't find an address or quite recall the doctor's or clinic's or hospital's name, etc. It happens; and it can affect the quality of healthcare.

4:50PM PDT on Mar 11, 2012

On the other hand, I keep having my medical records become lost or inaccessible. I have had so much trouble getting old providers to give me my medical records, so my new doctors have to start over without them. That causes all sorts of waste and potential medical harm. Electronic records would more easily be transferred, and would help a lot in cases like mine, where someone has to move around a lot. I'd rather we waste money on diagnostic procedures that might help than we waste money on paperwork and redoing tests because the old ones can't be found. And a decreased risk of medical problems being missed is worth more than money.

10:12AM PDT on Mar 11, 2012

The only thing that could save our health care is to cap pharmaceutical companies, and what can be charged for health care. It is not the real costs of health care that is killing us - but the astronomically amounts that health care providers are alloud to charge.

Look at Germany - Health care providers made Millions of Euros in profit last year and are now lowering their rates and give funds back to the country. Germans have the same health issues as everyone else - and receive better and more advanced health care - to fair prices! So what is wrong with the U.S. health care system?

6:38AM PDT on Mar 11, 2012

they don't mention if it changes the rate of prescribing.

11:17PM PST on Mar 10, 2012

Hell, at the moment,health care threatens to grow to consume the entire economy of not just the United States, but most of the developed world. If you want to use your go to example of Europe, they too face rising health care costs. Check our "Penny Health" to read articles on how to save money on health insurance.

11:09PM PST on Mar 10, 2012

electronic records haven't lowered the cost of anything here, let alone in health care

10:39PM PST on Mar 10, 2012

Most of the medical industry is more concerned with how much money they are going to make off you before their excessive medication management eventually kills you. They have become the proverbial bad mechanic leaving the car just broken enough to make sure you come back, only its your body, your life and your livelihood that is being nudged into being broken and continuously returning for more and more visits to get the fix of the drugs your body is being coaxed into depending on.

Visual diagnostics has taken hits in funding and availability but then again who needs real diagnostics when you can just plug people into a profile and start writing up the prescriptions.

9:53PM PST on Mar 10, 2012

Its not the format of the records- its how they are kept and used. Old computer axiom- "Garbage in; garbage out"

9:34PM PST on Mar 10, 2012

My doctor uses electronic records, when I see him, he has full access to my health record and can notice any changes in my stats immediately. The doctor my Mom goes to still uses paper files, and very often I have to remind her of a test she ordered on my Mom's last visit, or that a medication has changed. I prefer the electronic reasons for this reason if no other.

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