The authors of a study published in the March issue of Health Affairs found that their analyses of the records of 28,741 patient visits to 1,187 office-based physicians in 2008 “raise the possibility that, as currently implemented, electronic access [to test results] does not decrease test ordering in the office setting and may even increase it.”
We at HIMSS Analytics welcome broad-based research into the benefits of investments into healthcare information technology. We are firmly committed to speaking on behalf of the value for health IT to improve quality, safety, access and efficiency. We find this study interesting and compliment the authors on the size of their sample. We also wonder if behaviors and motivation have changed since this data was gathered in 2008, before the passage of the American Recovery and Reinvestment Act of 2009 and before concepts around bundled payment began to gel.
Dr. Farzad Mostashari, National Coordinator for Health IT, has expressed his surprise “that the authors go far beyond the scope of their research” in concluding that the EHR incentive program may not yield predicted cost savings by reductions in duplicative testing, when the study only “considered how physicians react to electronic viewing of imaging results, not EHRs.” Additionally, he writes, assessing the success of EHR systems should be “based on how they improve the care that patients receive, not just the number of tests ordered… The ultimate impact of EHRs on reducing cost will be through improvements in the coordination and quality of care, and the prevention of unnecessary and costly complications and hospitalizations.”
According to HIMSS Analytics data gathered from Stage 7 sites using the HIMSS Analytics EMR Adoption Model, the findings of this study are contraindicated at two large integrated delivery systems which use the same information system for ambulatory care and inpatient care and thus have a comprehensive continuity of care record.
One Stage 7 winner “trimmed by 12% outpatient lab use two years after the implementation…”
Another health system reported “inpatient lab tests have been reduced by 5% due to elimination of duplicate orders…” And that latter health system told us privately that the continuity of care record has saved them over $3 million to their health plan due to reduction in utilization and an increased shift to lower cost settings. Their break-even point from the IT investments was reached more than six months ahead of schedule.
We all know that implementing information systems takes time, but we also need to recognize that changing behaviors takes equally as much time. Incentives accelerate behavior change.
Are these findings from HIMSS Analytics Stage 7 hospitals different from the Health Affairs authors’ results because their physicians are all part of a integrated delivery network with one common goal, vs. any physician who has online access to results but no particular strong allegiance with the health system?
These are additional questions that should be researched. We look forward to further studies on the value of health IT to patients, health systems and the United States as a whole.
What’s your reaction to the Health Affairs study?