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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