Study: Labs, imaging increase with EHR access

If doctors can access test results electronically, do they order more or fewer lab and imaging tests than when they had paper charts? A study published in Health Affairs asserts the opposite of what you’d expect: They probably order more.

Researchers writing in the March issue of the journal say electronic test result access by office-based physicians “may not yield anticipated cost savings from reductions in duplicative or inappropriate diagnostic testing” and, in fact, could drive up costs.

“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,” says lead author Danny McCormick, MD, an internist and assistant professor of medicine at Harvard Medical School.

For their study, McCormick and colleagues analyzed data from the 2008 National Ambulatory Medical Care Survey, which includes 28,741 patient visits to a national sample of 1,187 physician-based offices.

Point-of-care electronic access to electronic imaging results, sometimes through an electronic health record, was associated with greater likelihood of an imaging test being ordered. Physicians without such access ordered imaging in 12.9% of visits, whereas physicians with access ordered imaging in 18.0% of visits.

Surgeons and other specialists were more likely to order imaging tests than were primary care physicians.

Several studies have estimated that computerization in physician offices would reduce testing costs. One study estimated savings of as much as $8.3 billion a year on imaging and $8.1 billion on lab testing McCormick and colleagues, however, say the predicted savings from this technology were based on incomplete data, relying on a few “flagship” healthcare institutions with highly advanced systems, and not generalizable to current medical practice, where computer technology is commonly an “off-the-shelf” product.

The study did not examine the reasons for physician behavior when it comes to test-ordering.

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