Health Affairs: Diagnostic imaging orders increase with health IT capabilities
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Several veins of logic have fueled the belief that the presence of EHRs and other health IT tools would result in fewer physician orders for diagnostic imaging, according to the authors of the study, led by Danny McCormick, MD, assistant professor at the Harvard Medical School in Boston and a director at the Cambridge Health Alliance in Cambridge, Mass.
Redundant testing was supposed to decrease, access to more patient information should have reduced the need for diagnostic imaging and clinical decision support should have discouraged providers from ordering so many tests, McCormick wrote. “However, it is also plausible that more convenient access to results could encourage physicians to increase their ordering.”
McCormick’s research indicated that the latter is more likely. He and his colleagues examined 28,741 patient visits to 1,187 providers represented in the 2008 National Ambulatory Medicare Care Survey and determined that the computerized availability of imaging results in an EHR or other device resulted in a 40 to 70 percent greater likelihood an imaging test would be ordered.
A total of 4,335 orders for any imaging test were examined and 18 percent of visits to providers with electronic access to imaging tests resulted in an order compared to 13 percent of visits to providers without access. Additionally, a total of 1,117 orders for an advanced imaging tests were examined and were 70 percent more likely to originate in the office of a provider with electronic access to results.
The results prompted researchers to predict that health IT may not deliver on its promise to reduce costs by encouraging more parsimonious care. While researchers did not identify a clear cause to the increase in orders for diagnostic imaging, they suggested that substituting several keystrokes for the task of tracking down physical imaging results has encouraged providers to overuse the ability, or there may be a relationship between health IT adoption, self-owned practices and self-referral rates.
Based on their conclusions, researchers suggested that provider and payor organizations be wary of claims that health IT reduces orders for redundant tests and that other methods for curtailing redundant testing be identified.
“Whatever the explanation for our findings they emphasize the importance of establishing the benefits of computerization rather than estimating them in the absence of data, or generalizing from small studies at a few atypical institutions,” McCormick and colleagues concluded.