National Coordinator for Health Information Technology Dr. Farzad Mostashari took issue with a study appearing in Health Affairs this month linking electronic access to imaging results with increased imaging utilization.

"Seemingly surprising headlines can be tempting, but it's important to get the facts," he said on his organization's blog, HealthIT Buzz, yesterday.

The study said doctors who had computerized access to imaging and bloodwork results ordered 40 to 70 percent more tests and thus it wasn't clear if the government's push for health information technology (which Mostashari is part of) would help control utilization or save the health care system money.

Mostashari said while it's "not particularly surprising" that doctors who order a lot of tests would have electronic tools for viewing those tests, he suggested that jumping from that observation to arguing that the government's efforts to encourage electronic health record adoption might not result in cost savings is a stretch.

"McCormick's study ultimately tells us little about the ability of electronic health records to reduce costs" or improve care, he wrote.

For one, he said, the study looked at electronic viewing of imaging tests, not electronic health records themselves. Even if it did, the study's data date from 2008, before the government set up its incentive program to reward the "meaningful use" of EHRs. Also, clinical decision support tools, which can help guide doctors into ordering appropriate tests and share information, were not examined, even though they're among the "most critical features of certified EHRs," Mostashari said.

Moreover, the study could only track correlation, not causality, Mostashari notes: a system with easily gotten imaging results might encourage doctors to order more tests, but it's also possible that doctors who are already ordering a lot of tests would then want to get a convenient viewing system.

"The authors themselves correctly note that physicians who have a financial stake in imaging are more likely to purchase systems with image results capabilities, making self-referral a likely explanation for their results," he said.

He also suggested that the "ultimate impact" of EHRs would lie in better coordination of patient care and preventing unnecessary complications and hospitalizations, not necessarily in cutting back on test utilization.

Plus, just focusing on the number of tests ordered can be misleading, as the study didn't account for whether any of the additional tests ordered were medically necessary or not, Mostashari argued.

"As both patients and providers well know, an appropriate follow up for a suspicious nodule is a test you want to have," he said. "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."

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