HIT battle: ONC director, imaging study authors at odds

A major study released last week linking physicians’ electronic access to records with higher healthcare costs has sparked a war of words between the government office dedicated to health information technology (HIT) and the study’s authors.

Medical Economics eConsult shared the results of a study published in the March 2012 issue of Health Affairs, showing a greater likelihood of imaging and lab orders by physicians who had electronic access to the results.

Refuting the report, the Office of the National Coordinator (ONC) for HIT says you might not be ordering more imaging and lab tests just because you are able to access the results electronically.

National Coordinator Farzad Mostashari, MD, ScM wrote in his blog last week on the ONC’s Web site that the study “tells us little about the ability of electronic health records (EHRs) to reduce costs,” and “tells us nothing about the impact of EHRs on improving care.”

The article’s authors promptly posted their own blog, saying “some of the assertions in [Mostashari’s] blog are mistaken” and accusing Mostashari of “wishful thinking regarding health IT.”

Mostashari disputes the authors’ claims that the “adoption of health information technology may not yield anticipated cost savings from reductions in duplicative diagnostic testing,” and that the changes “will drive costs in this area up, not down.”

Mostashari writes that the study’s authors considered only how physicians react to electronic viewing of imaging results, not EHRs in general. When the authors looked at EHR use, they found that “use of an electronic health record system showed no association with test ordering.” In addition, he also points out that the study data were from 2008, before the passage of legislation linking payment incentives to the meaningful use of EHRs.

The study did not consider other variables that could affect physician behavior such as having a sicker patient population, the level of physician training, approach to defensive medicine, or if the physicians had a financial stake in imaging, he writes.

“The study also looked at the quantity of tests ordered without any regard to whether the tests were medically necessary,” he writes. “Clearly, we need to assess the success of EHR systems based on how they improve the care that patients receive, not just the number of tests ordered.”

The authors – Danny McCormick, David Bor, Stephanie Woolhandler, and David Himmelstein, all associate professors at Harvard Medical School – responded by saying they performed a series of subsidiary analyses that addressed these issues.

They hope the situation will create “fruitful dialogue” and lead to more studies on the subject.

“Dr. Mostashari is perhaps the only person in our nation who commands the resources needed to mount a well done randomized controlled trial to fairly assess the impact of health IT, and the comparative efficacy of the various EHR options,” they write.

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