A recent study cited in the New York Times today concluded that ‘digital records may not cut health costs.’ It was performed by the RAND Corporation and published in the journal Health Affairs (http://content.healthaffairs.org/content/31/3/488.abstract ). Specifically, it was composed of 28,741 patient visits to 1187 physician practices, and demonstrated that when previous computerized medical imaging studies were available (not necessarily in the context of electronic medical records), further imaging tests were ordered for 18% of patients, versus 12.5% for those without such results available, an increase of 40%. It was also interesting to note that there was a 70% increase if those available image results were from complex imaging modalities like MRI or CT scans. There was an increase in lab result ordering if these were available as well. Female patients received more test orders than men, and surgeons ordered more imaging studies than primary care physicians. The reasons for the physician behavior were not described in the study article.
One is stricken by headlines in social media declaring that the adoption of EHRs is a financial liability. The Times stated that the study concludes that “digital records may not cut health costs.’ While technically correct in their statement, a layperson reading this and not the study itself may draw the conclusion that ‘digital records’ refers to electronic health records. The computerization of the tests was not necessarily in the context of electronic health records. The data originated from a 2008 study, the National Ambulatory Medical Care Survey, predating the vast majority of the EHR adoption seen today. This article raises a few questions, even if one would presuppose that they were all available in an EHR. If EHRs increase costs but improve outcomes and patient safety (yet to be demonstrated in large numbers), should its adoption be considered a failure? Shouldn’t records be electronic, if nothing else to facilitate communication among providers, patients, and other stakeholders as well as catching up to other sectors of society? There have been other studies both demonstrating cost increases and decreases resulting from EHR adoption. EHRs have still not yet been adopted by a large majority of providers. Is it too early to draw sweeping conclusions? Granted economics should be a major driver of any reform of healthcare. Unless, however, we put cost analysis of a patient in a broader term than just looking at how many tests are ordered, we are short-changing the entire movement of reform which consists of insurance reform, the change to bundled payments, the establishment of accountable care organizations. Conclusions about the financial impact of EHRs, positive or negative, from this study are scientifically irresponsible. This demonstrates the importance of reading a study’s methods, results, and conclusions, something all healthcare providers are taught to do.