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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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.

EHR technology can reduce health care costs…right?

Check out this NYT article: 

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?