Today’s Managing Health Care Costs Indicator is 18%
Researchers from Cambridge Health Alliance reported yesterday in Health Affairs that physicians who had electronic access to the results of imaging tests were 30-70% more likely to order such tests as physicians who did not have access to electronic reports on the results of the imaging studies. 18% of visits to physicians with electronic access to results were associated with an imaging test, compared to 12.9% of visits to physicians without such access. Note that it wasn’t the presence of an EMR or electronic ordering alone – it was presence of electronic access to the results. They studied a nationally representative database of physician office visits.
By the way - more than one visit in 8 resulted in an imaging test without EMRs. This suggests rampant overutilization.
The researchers did an exhaustive number of regression analyses – trying to see if characteristics of patients or physicians were more likely to be the cause. Could it have been self referral? Or possibly physician specialty? They came up dry – the overwhelming association was that access to electronic results yielded more testing.
Many advocates of electronic medical records have overstated their likely cost savings, including duplicative tests. Duplicated tests often have small marginal costs anyway –and this study suggests that if anything effective EMRs might be associated with more, rather than less imaging.
EMRs are adding value by preventing errors, facilitating coordination, helping encourage physicians to follow evidence-based guidelines, and by allowing better benchmarking and reporting to physicians about their performance. They’ll probably eventually save dollars by facilitating reporting on variation, and encouraging more evidence-based care. There are many benefits to EMRs, even if we can’t claim that they will save billions of dollars through decreased imaging utilization.