Mostashari: Study on e-access and medical imaging doesn't get all the facts

National Coordinator for Health IT Farzad Mostashari, M.D., wrote a scathing post Tuesday on the Health IT Buzz blog in response to 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.

In addition to pointing out that the study failed to take into account the medical necessity of the tests ordered, Mostashari also said that the authors did not consider clinical decision support or the ability to exchange information electronically--both of which, he added, have been shown to reduce duplicate tests.

"While such interpretations may make for attention-getting headlines, it's important to get the facts," Mostashari wrote. "There are several reasons why [lead author Danny] McCormick's study ultimately tells us little about the ability of electronic health records to reduce costs, and why it tells us nothing about the impact of EHRs on improving care."

Mostashari also said that improvements to the coordination and quality of care given, not a reduction in the number of tests ordered, was the primary focus of EHRs in the first place. "Providers who are embracing new delivery and payment models such as Accountable Care Organizations and Patient-Centered Medical Homes know that Meaningful Use of EHRs is a critical foundation for being able to improve quality while reducing cost," he said.

The National Coordinator wasn't the only person critical of the study. Merrill Goozner, a senior correspondent for The Fiscal Times, wrote in a post that appeared on The Health Care Blog that the study's results were "obvious."

"Absent other incentives, why would anyone expect otherwise?" Goozner said of electronic access increasing the volume of tests ordered. "Imaging is one of the great generators of ‘false positives' in the medical system. ... The depressing fact is that under the current fee-for-service payment system, everyone gets paid that second time around."

Goozner added that while he thinks EHRs are "extraordinarily important tools" for tracking patients, avoiding errors and eliminating duplication, he believes the impact of those tools on a financial level will continue to be minimal until payment and delivery system reforms can take hold.

For more information:
- read Mostashari's post
- here's Goozner's post

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