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Health Care: Debate Rages Over Cost Effectiveness of EHRs
A recent study from Harvard Medical School and CUNY School of Public Health is stoking tensions in the debate about whether EHRs are as cost effective as they are portrayed by proponents of the technology. The conclusions of the new report suggest that the use of Electronic Health Records may do little to cut the high cost of delivering medicine. In fact, the report suggests that EHRs may actually encourage doctors to prescribe more tests, resulting in higher costs.
The findings run counter to the results of earlier reports. RAND researchers Richard Hillestad and colleagues, for example, estimated that there would be an immediate savings of $80 billion if physicians used EHRs (assuming an overnight 100 percent adoption rate), with an annual mean savings of $40 billion over the next fifteen years.
One area where EHRs are expected to reduce costs is with the reduction in the amount of imaging and lab tests needed to be ordered for a patient. The availability of the EHR history is expected to eliminate the need for the duplication and overlapping of testing when a patient consults with multiple physicians. Previous studies had suggested that the use of EHRs would lead to an $8.3 billion year savings by reducing the need for imaging and lab testing.
But, the results of this new study question that thinking. The study looked at how the care provided by office-based doctors differed based on whether or not an EHR for the patient was available. The study considered 28,700 patient visits to nearly 1,200 doctors and found that physicians with access to the patient’s EHR ordered imaging 18 percent of the time, compared to 13 percent of the time when doctors did not have access to the patient EHR. Based on the results of this single sample, recent headlines have questioned the cost savings of EHRs.
Danny McCormick, a physician and assistant professor of medicine at Harvard Medical School and lead author of the report said that “our findings should at a minimum raise questions about the whole idea that computerization decreases test ordering and therefore costs in the real world of outpatient practice. As with many other things, if you make things easier to do, people will do them more often… Our research raises real concerns about whether health information technology is going to be the answer to reducing costs… The federal government’s ongoing, multibillion-dollar effort to promote the adoption of health information technology may not yield anticipated cost savings from reductions in duplicative diagnostic testing. Indeed, it is possible that computerization will drive costs in this area up, not down.
The results of the new study though were refuted by proponents of EHRs. Dr. David Blumenthal, former Harvard professor and national coordinator for health information technology at the Department of Health and Human Services for the Obama administration from 2009-2011, told the PBS news hour that “This is one of many, many studies, and the studies are overwhelmingly supportive of cost-reductions by using electronic health records. Anytime you see anything that is complicated like this (the implementation of EHR throughout the system), some studies will be positive, some will be negative. But if you look at the total review of literature that was done a year ago, it puts it into context: 92 percent of studies were positive. I expect that if you study something 100 times, there’s going to be some variation.”
Farzad Mostashari, MD and National Coordinator for Health Information Technology, blasted the study by McCormick, found numerous faults with the study, one of which is that ” the authors did not consider clinical decision support, which helps give providers the data tools they need to make appropriate care recommendations and the ability to exchange information electronically. These are two of the most critical features of certified EHRs, which have been shown in multiple well-designed studies to reduce unnecessary and duplicative tests.”
