EHRs and Health Information Exchange: Will increased access decrease costs?

The federal dollars in the HITECH act, and much of the enthusiasm for new innovation in the healthcare IT space is predicated on the assumption that better access to information will result in better and cheaper care.  Avoiding unnecessary duplicated studies, especially, expensive medical imaging, is one way that’s supposed to happen.


As a medical imaging specialist, I can attest to the fact that unnecessary and wasteful imaging tests get ordered all the time, at significant cost.  It see it many times a day, and I’m a believer in the power of increased access to health records.

Two articles have recently been published in the medical literature that aim to test this assumption.  And the results seem to be in conflict.  The first article, published in the Journal of Health Affairs, examined access to medical imaging and results, and found that physicians with electronic access were actually more likely to order additional imaging tests.  The second article, published in the Archives of Internal Medicine, found that doctors ordered 49% fewer lab tests after the introduction of an electronic health information exchange (HIE).

So, what are we to believe?  I’ll try to make some sense of this.

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EHR Innovators Part 2: drchrono

drchrono ehr digital health

This is the 2nd part in my round up of 4 EHR innovators that have caught my attention.  Last week I covered Practice Fusion.

Today I’m taking a look at drchrono.

Next week, we’ll check out hellohealth and
Avado.  There are other EHR/EMRs.  Lots.  Why aren’t they listed above?  They haven’t grabbed my attention yet.  Am I missing someone exciting?  Drop it in the comments!

In an earlier post I wrote about the top 5 features I need and my patients need in an innovative EHR: Integration, Web-based Interoperability, Mobility, Provider Sharing and Patient Access.  I’m evaluation how each of these EHR innovators does on meeting these top 5 features.

On to drchrono…

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EHR Innovators Part 1: Practice Fusion

As promised, this is the first in a multipart series, about the innovation going on in the Electronic Health Record space.  This isn’t meant to be a comprehensive review of all the EHR vendors out there.  It’s a short list of a few of the EHRs that have caught my attention for being innovative or exciting.  Those EHRs that make it easy and free to sign up I’ve evaluated first hand.  Those that don’t I’ve evaluated based on their own feature lists, demonstations and published materials.  This isn’t mean to be a usability evaluation, but just an overview of what’s being done out there.

So, here’s the group that has my attention:
Practice Fusion
drchrono
hellohealth
Avado
There are others.  Lot’s.  Why aren’t they listed above?  They haven’t grabbed my attention yet.  Am I missing someone exciting?  Drop it in the comments!

<begin digression>
A short digression on EHRs and disruption:  In my *ever-so-humble* opinion, the innovative EHR is not a truly disruptive technology, by strict definition.  Maybe Clay Christensen would disagree (in which case I would submit), or maybe history will prove me short-sighted and wrong.   But, I believe that in spite of the exciting innovation in this space, EHR innovation won’t replace or up-end any markets, particularly the market that it most directly influences: the Doctor-Patient(-Insurance) transactional market.  I do think EHR innovation may expand or create new markets.  It will reduce waste and inefficiencies.  It will improve care.  But it won’t truly disrupt the market.  It’s not going to take us from the realm of treatment/reaction medicine to preventative medicine.  It’s not going to change the payer models.  It’s not going to change the customer.  It doesn’t fit the pattern of disruptive technologies layed out in The Innovator’s Dilemma.  I see it as exciting evolution, but not revolution.
</end digression>

In an earlier post I wrote about the top 5 features I need and my patients need in an innovative EHR: Integration, Web-based Interoperability, Mobility, Provider Sharing and Patient Access.  I’m going to evaluate how each of these EHR innovators does on meeting my top 5 needs, starting with Practice Fusion.

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Top 5 things my patients and I need in an EHR

There is a lot of exciting innovation in the Electronic Medical Record space right now, in part thanks to meaningful use dollars available from the American Reinvestment and Recovery Act.

That is good new for patients and doctors both.  I’ve got my eye on a few of innovators in the space, both young startups and more mature companies.  I’ll write about some of them soon.  But first I wanted to list some of the key features that an innovative (or disruptive!) EHR should include.  I’m not talking about HL7 feeds and HIPAA compliance here.  Those kinds of things are important, but I’m interested in innovations that have the potential to be transformative—or at least empowering.

#5 – Integration – Especially with medical imaging

OK, I know I just said I wasn’t talking about HL7 feeds.  But there is more to EHR integration.  When I publish this post, it will automatically get posted to Twitter and Facebook…without HL7, thanks to APIs.  Any EHR worth its salt should expose an API so that others can integrate with it, extend it, and innovate on top of it.

This is especially important when it comes to viewing medical images, like CT scans and MRIs.  Ideally, the EHR itself should be what I call the “clinical viewer.”  (A clinical viewer is like a PACS that emphasizes clinical necessity and convenience over advanced visualization tools.)  But, most EHRs aren’t there yet, and clinical viewers are in their infancy, a topic I’m speaking on at the Society for Imaging Informatics in Medicine this June.  So, if the EHR can’t have a clinical viewer built right into it, it should at least expose an API robust enough for a clinical viewer, or any other clinical application, to integrate with it.

Why?  Because medical images are freaking important, that’s why.  And so are about a million other different things and use cases, including a boat load that haven’t even been thought of yet.  Closed platforms are sooo 2001.

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Health IT Czar: Survey doesn’t capture savings

When we talk about health IT reducing healthcare costs, it’s not going to come about by more or fewer lab tests. The big savings will come from improvements in the coordination of care.

 -Farzad Mostashari, federal health IT czar

I agree.  And with the role that medical imaging now plays in determining the course of care, medical imagers must play a crucial role in that coordination.

http://www.healthcareitnews.com/news/mostashari-rankled-over-hit-survey-conclusions

EHR technology can reduce health care costs…right?

Check out this NYT article:  http://nyti.ms/z8eY93 

Common wisdom is that electronic medical records—and eventually electronic medical clearinghouses and medical information exchanges—can decrease healthcare costs by giving doctors a more complete patient record.  This would eliminate duplicate tests and studies, which are expensive.

I have to admit I buy into that thinking.  As the specialist that reads imaging tests, I see many, many tests get ordered unnecessarily, because the doctor who ordered them didn’t know the patient already had a similar test recently.  In fact, I see this problem several times a day, which means thousands of dollars a day in waste.

But this study calls the wisdom that digital records can save money in to question.  In fact, doctors who had electronic  access to imaging test results ordered MORE imaging tests than doctors who did not.

I’m surprised.  But we don’t need to throw in the towel on digital records as a cost saving yet.   First, this didn’t look at quality, which is hard to assess.  It could well be that the doctors with more information knew better what additional tests were needed, and ordered them.  I simply can’t see how giving doctors MORE information about their patients could do anything but IMPROVE quality.  It could also be that overall costs (not measured) were lower even though more tests were ordered—for example, if diseases were diagnosed and treated sooner.

What do you think?  Are digital health records overrated as a cost saving strategy?