Mostashari Slams Study Linking EHRs With More Imaging Orders

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During a meeting of the Health IT Policy Committee on Wednesday, National Coordinator for Health IT Farzad Mostashari criticized aspects of a recent Health Affairs study that suggested that electronic health records could encourage physicians to order imaging tests more frequently, Healthcare Informatics reports (Raths, Healthcare Informatics, 3/7).

About the Study

The study, conducted by the Cambridge Health Alliance, found that physicians with electronic access to patients' previous imaging results ordered tests 40% more frequently than those using paper records.

Although the study did not explore the reasons physicians who use EHRs order more tests, the researchers said the technology could make ordering tests easier.

Danny McCormick, lead author of the study, said the research "raises real concerns about whether health information technology is going to be the answer to reducing costs" (iHealthBeat, 3/6).

Comments at Health IT Policy Committee Meeting

During the Policy Committee meeting, Mostashari said, "It is not a particularly surprising observation" that clinicians with electronic access to imaging tests order more tests. However, he said the surprising element of the study is the researchers' conclusion that the federal government's meaningful use program might not yield cost savings.

Under the 2009 federal economic stimulus package, health care providers who demonstrate meaningful use of certified EHR systems can qualify for Medicaid and Medicare incentive payments.

Mostashari said that the data used in the Health Affairs study were from 2008, before the start of the meaningful use program.

He also noted that the study was observational and was not designed to draw conclusions about how EHRs could affect costs or care quality. Mostashari said, "Despite the power of anecdote and headlines making an impact on our consciousness, we have to be careful to look at evidence systematically and not anecdotally."

He added, "Finally, when we talk about health IT being the foundation for improving quality and safety and reducing costs, it is not going to come about by people ordering more or fewer lab tests. The big savings are in improvements in coordination of care, and reducing unnecessary and harmful complications and hospitalizations" (Healthcare Informatics, 3/7).

Post on 'Health IT Buzz' Blog

On Tuesday, Mostashari published a "Health IT Buzz" blog post outlining his concerns about the Health Affairs study.

He wrote that the study "tells us little about the ability of [EHRs] to reduce costs" and "nothing about the impact of EHRs on improving care."

According to Mostashari, the study looked specifically at the electronic viewing of imaging tests, not at the use of EHR systems themselves (Gold, "Capsules," Kaiser Health News, 3/7). He added that the researchers did not consider other elements of EHRs -- such as clinical decision support applications or health information exchange tools -- which have been shown to reduce duplicative tests (Bowman, FierceHealthIT, 3/7).

In addition, Mostashari noted that the researchers did not examine whether the additional imaging tests were medically necessary and whether they actually improved care quality ("Capsules," Kaiser Health News, 3/7).

Robert Forster
With all of the wishful thinkers (Mostashari included) BELIEVING that IT/EHR/HIE will transform medical care delivery for the good, a flawed for sure but initial study questioning the impact on cost is quickly dismissed and labeled as uncredible. We should look at the study for what it has to offer and at least question some of our assumptions and beliefs. Those who quickly dismiss should not be trusted to present data without bias.

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