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Another issue reported for electronic medical records

Robin Wulffson MD's picture
electronic medical records, healthcare costs, unnecessary tests

Electronic medical records (EMRs) offer numerous advantages over traditional paper medical records. Among them, is the ready availability of one’s medical history at just about any location on the globe. This advantage is negated somewhat by the possibility that personal information could fall in the wrong hands. Now, another potential down-side of EMRs has been reported.

Proponents of EMRs tout the concept that streamlined EMRs can help trim soaring healthcare costs; however, a new report found that EMRs could actually increase costs. Their findings were published in the March 2012 edition of the journal Health Affairs. One of the arguments for EMRs is that it will lower the cost of care because a healthcare provider would have ready access to a patient’s previous laboratory and imaging tests, he or she would be less likely to order an unnecessary repeat test.

A research team lead by Danny McCormick, an assistant professor of medicine at Harvard Medical School (Boston, MA) conducted a study to test the concept that easy access to medical records would pare healthcare costs. They reviewed the records of 28,741 patient visits to a nationally representative sample of 1,187 office-based physicians in 2008. They found that doctor’s access to computerized imaging results (sometimes, but not necessarily, through an EMR) was associated with a 40–70%t greater likelihood of another imaging test being ordered. In addition, the electronic availability of laboratory test results was associated with the ordering of additional blood tests. The researchers noted that the availability of an EMR in itself had no apparent influence on the ordering of further tests; however, the easy access to the test results appeared to have been the key factor. In other words, with a mouse click, the physician can order a test.

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The authors concluded that their findings raised the possibility that, physicians who have ready access to healthcare records does not decrease test ordering in the office setting and may even increase it. They suggested that current electronic systems include features that are enticements to ordering tests. They 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.”

The current study is not the only one pointing to flaws in EMRS. A January 2012 report by the Bipartisan Policy Center noted that promoting the use of EMRs and other health IT “enjoys bipartisan support.” However, it is also being driven by billions of dollars in government incentives. The report notes that currently there are gaps and barriers in the assumption that health IT can help improve health outcomes, improve the experience of care, and save money. One of the shortcomings of current systems is a lack of health information exchange. Often, it is difficult for physicians and hospitals to exchange healthcare information. The study notes that improved systems for information exchange would likely pare costs.

In addition to reported shortcomings, EMRs are currently not widely utilized by patients to either manage their healthcare or coordinate with a healthcare provider. The government study found that only 7-11% of Americans currently use some form of online personal health record.

Health Affairs
Bipartisan Policy Center