Electronic Image Access Encourages Test Ordering?

A major impetus behind adoption of electronic health records has been the reasoning that they could help reduce healthcare spending, in part, by reducing redundant imaging tests.

But a study published in Health Affairs challenges that conventional wisdom: Researchers found physicians who have electronic access to previous imaging results are actually more likely to order additional tests.

Access to computerized imaging results was associated with a 40 percent to 70 percent greater likelihood that an office-based physician will order an imaging test, according to researchers from Harvard-affiliated Cambridge Health Alliance in Cambridge, Mass., and the City University of New York School of Public Health at Hunter College in New York. Access to lab results was also associated with ordering more blood tests.

The availability of the EHR itself had no apparent impact on order; it was access to test results, researchers said. They analyzed the records of 28,741 patient visits to a nationally representative sample of 1,187 office-based physicians in 2008.

The researchers said the federal government’s effort to promote widespread EHR use “may not yield anticipated cost savings from reductions in duplicative or inappropriate diagnostic testing.”

“These findings raise the possibility that, as currently implemented, electronic access does not decrease test ordering in the office setting and may even increase it, possibly because of system features that are enticements to ordering,” the authors wrote. “We conclude that use of these health information technologies, whatever their other benefits, remains unproven as an effective cost-control strategy with respect to reducing the ordering of unnecessary tests.”

Their findings run contrary to other studies that have found access to prior images reduces repeat ordering and thus saves billions of dollars. However, researchers said previous studies were based on “flagship” institutions, not representative of office-based practices and technology.

One caveat here is that the study is based on 2008 data, when fewer physicians used EHRs and shared imaging and other patient data. Second, the study doesn’t tell us why access led to more tests ordered.

Study author Danny McCormick tells the WSJ Health Blog that although their research doesn’t point to a reason, they have some ideas, including that if doctors know an image result will conveniently show up on the screen, they may be more inclined to order the test. Or doctors who order more imaging studies are more likely to have health IT on which to view the studies, he said.

Finally, he said that the results don’t determine whether the imaging tests are appropriate or not.

What do you think of this study?