The health IT community reacted quickly this week to condemn to the recent Health Affairs study that found electronic access to medical images actually increased test ordering.
Researchers found that access to computerized imaging results was associated with a 40 percent to 70 percent greater likelihood that a physician would order an imaging test. The availability of the electronic health record had no impact on ordering, however, the researchers said the findings suggest the government’s efforts to promote EHR use “may not yield anticipated cost savings from reductions in duplicative or inappropriate diagnostic testing.”
Not surprisingly, many in the imaging and health IT sector took issue with the study.
Farzad Mostashari, MD, National Coordinator for Health Information Technology slammed the study on the ONC’s Health IT Buzz blog, pointing out several ways the study is flawed, including that it was based on 2008 data and didn’t consider physician use of EHRs.
Mostashari also noted that the authors didn’t consider clinical decision support and the ability to exchange information electronically, which he said were “two of the most critical features of certified EHRs.”
He continued: “The study also looked at the quantity of tests ordered without any regard to whether the tests were medically necessary. As both patients and providers well know, an appropriate follow-up for a suspicious nodule is a test you want to have.”
Erica Drazen, managing director of CSC’s Global Institute for Emerging Healthcare Practices, also denounced the study, noting in an interview that as an epidemiological study, there’s no way to determine causation. Had it been a randomized clinical trial, researchers could have assessed whether physicians’ ordering behavior changed after acquiring imaging access. Epidemiological studies are usually used to formulate questions, she said, rather than find answers.
“The only thing this study showed was that physician who ordered a lot of tests also had access to systems to view images in their office practices,” Drazen said. “This really doesn’t contribute anything to our understanding of how to reduce unnecessary imaging tests and certainly doesn’t tell us about the impact of EHRs.”
Drazen also took issue with the article title, which she said was misleading, and the fact that the news media drew conclusions about the federal EHR program that weren’t supported by the information.
"People in the know are concerned about this because we think there is misinformation here. There are a lot of skeptics about EHRs so this kind of fuels the fire,” she said.
However, Drazen said the impact of the study will ultimately be minimal. Policymakers, she said, understand the limitations of this kind of study. “Don’t pay any attention to this,” she said, “It doesn’t add to our knowledge.”