Mostashari: Health Affairs study flawed, misleading

Farzad Mostashari, MD

Writing on the Health IT Buzz blog, National Coordinator for Health IT Farzad Mostashari, MD, eviscerated the study published this week in Health Affairs that concluded that electronic access to medical imaging and lab results led doctors to order more imaging and blood tests. 

The finding that doctors who order a lot of imaging tests are more likely to have electronic systems that let them view those images in their offices “is not a particularly surprising observation,” Mostashari wrote. He said that the study’s findings resulted in attention-getting headlines but didn’t include all the facts.

The study, led by Danny McCormick, MD, of Harvard Medical School in Boston, considered how physicians react to electronic viewing of imaging results, not EHRs, and Mostashari pointed out that the study data were from 2008, before payment incentives were linked to the meaningful use of EHRs.

Mostashari also said the authors did not consider clinical decision support or the ability to exchange information electronically, “two of the most critical features of certified EHRs which have been shown in multiple well-designed studies to reduce unnecessary and duplicative tests.”

The Health Affairs observational study did not allow for the study of several variables that could affect physician behavior, including having a sicker patient population, level of physician training and financial arrangements. It also looked at the quantity of tests ordered without any regard to whether the tests were medically necessary, Mostashari said. “As both patients and providers well know, an appropriate follow-up for a suspicious nodule is a test you want to have. Clearly, we need to assess the success of EHR systems based on how they improve the care that patients receive, not just the number of tests ordered. Unfortunately, this study focused on the numbers, while ignoring the patients.”

He said EHRs ultimately will reduce cost through better coordination and quality of care and the prevention of unnecessary and costly complications.

Mostashari told his readers not to believe the hype, especially since a 2011 study in Health Affairs itself found that 92 percent of studies on health IT found overall positive results in improving efficiency, reducing unnecessary tests and improving the quality of care that patients receive. “The evidence shows we are on the right track to establishing the health IT foundations for a true 21st century U.S. health system where patients get better care while we reduce healthcare costs.”

The Health IT Buzz blog is a service of ONC to answer questions about the transition to EHRs and to create a conversation about the challenges and successes healthcare providers, physicians, practices and organizations are experiencing as they transition from paper to EHRs.