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Computerized patient records have been hailed as a major cost-cutter, and are a big part of the Affordable Care Act. Industry experts have estimated savings of as much as 80 billion dollars a year, according to the RAND corporation. More and more hospitals are switching to computerized records (known also as Electronic Medical Records and Electronic Health Records) in advance of the 2014 deadline.
However, a new study has found that while the computerized patient records save money in some ways, they end up not cutting costs overall. The reason is that doctors who are looking at patients’ records in the computerized version are more likely to order expensive tests than doctors looking at old-fashioned paper records, according to this article in the New York Times that reports on the study.
Health policy experts who have championed the adoption of electronic health records were critical of the study. They noted that the data came from the National Ambulatory Medical Care Survey, which is intended mainly for another purpose — to assess how medical care is practiced.
The study, they noted, included any kind of computer access to tracking images, no matter how old or isolated the function.
By contrast, modern electronic health records are meant to give doctors an integrated view of a patient’s care, including medical history, treatments, medications and past tests. The 2008 data predates federal incentive payments for doctors and standards for the “meaningful use” of electronic health records that began last year.
The new study, they said, was also at odds with previous research. It is “one of a small minority of studies” that have doubted the value of health information technology, said Dr. David Blumenthal, a professor at the Harvard Medical School.
Dr. Blumenthal, the former national coordinator for health information technology in the Obama administration, was co-author of a study, published last year in Health Affairs, that surveyed articles in professional journals in recent years on electronic health records.
It found that 92 percent of those articles were “positive over all” about the prospect that technology would improve the efficiency and quality of care.
But Dr. McCormick said the previous research had been primarily statistical models of expected savings, like the RAND study, or research that looked at the use of electronic health records at a relatively small number of flagship health systems.
“We looked at not just a few cutting-edge institutions, but a nationally representative sample,” Dr. McCormick said.
Dr. David J. Brailer, who was the national coordinator for health information technology in the administration of George W. Bush, said he was unconvinced by the study’s conclusions because they were based on a correlation in the data and were not the result of a controlled test.
The study did not explore why physicians in computerized offices ordered more tests. Dr. McCormick speculated that digital technology might simply make ordering tests easier.
Dr. McCormick said he hoped the study would damp any inflated expectations about electronic records. But he added that the technology can improve the actual practice of medicine.
The Cambridge Health Alliance, where he practices, made the switch to electronic records in 2005.
“I’m a primary care doctor,” Dr. McCormick said, “and I would never go back.”