National IT Coordinator Refutes Health Affairs Study on EHRs

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The national coordinator for health information technology fired back against a study published this week in Health Affairs, which stated that electronic health records may actually lead to more diagnostic testing rather than less.

Farzad Mostashari MD, writes in a blog post at HealthIt.gov that the study “tells us little about the ability of electronic health records (EHRs) to reduce costs and nothing about the impact of EHRs on improving care.”

Mostashari argues that the study did not address EHR use at all. Instead it looked at the availability to view medical imaging exams, likely through PACS. The authors also did not consider clinical decision support tools now available to doctors. And the study is outdated, performed in 2008 before the HITECH Act that linked payment incentives to meaningful use.

The association found in the study between EHRs and increased testing does not suggest causality, Mostashari writes. “Ordering more tests may lead to buying an image viewing system, not the other way around,” he states.

Other factors such as patient population, the level of physician training, financial arrangements and the approach to defensive medicine may also come into play, Mostashari writes.

Finally, Mostashari says that EHRs do not specifically lower costs by reducing unnecessary tests, but by “improvements in the coordination and quality of care, and the prevention of unnecessary and costly complications and hospitalizations.”

Read an interview with Mostashari and Todd Park, chief technology officer at HHS, in the current issue of Radiology Business Journal.