Study authors fire back at Mostashari after critical commentary

Attention Farzad Mostashari: The electronic-access-leads-to-more-testing ball now is officially back in your court. In a commentary posted online yesterday on the Health Affairs website, Danny McCormick and colleagues--authors of the highly-publicized study claiming that doctors who have electronic access to test results are likely to order increased imaging and blood tests--return serve to the National Coordinator for Health IT, who criticized the study's findings in a commentary last week.

In his commentary, Mostshari said the study was good for "attention-getting headlines," and added that it "ultimately tells us little about little about the ability of electronic health records to reduce costs" and "nothing about the impact of EHRs on improving care."

In picking apart several of Mostashari's claims, McCormick and his colleagues call the ONC head "mistaken" and add that he suffers from "wishful thinking regarding health IT."

The study authors reiterate their findings that electronic access for physicians led to an increase in imaging tests ordered between 40 percent and 70 percent.

"Although the survey did not collect data on payments for the tests, it's hard to imagine how a 40 percent to 70 percent increase in testing could fail to increase imaging costs," they say.

McCormick and his colleagues also say that Mostashari directly contradicts former ONC head David Blumenthal by saying that cost reduction isn't meant to be attained via reduced test orders. In an interview with CommonHealth last May, they point out, Blumenthal told a story about a patient who avoided an unnecessary test when prior imaging tests were accessed.

"It avoided the money and it avoided her inconvenience, it was a total win," Blumenthal said. "To me, that symbolizes the way forward. I thought to myself, if that could happen tens of thousands of times a day all through our healthcare system, it would be a dramatic change, and without any controversy."

The commentary also bashes Mostashari for claiming that many of the doctors ordering an increased number of tests want to purchase IT tools to view results electronically. "He offers no evidence for this assertion and ignores the fact that we explored [and rejected] this explanation by analyzing subgroups of doctors who are unlikely to be the decision maker for IT purchases," they say.

Ultimately, McCormick and his team hope that their response continues to create "fruitful dialogue" on the subject.

"We trust that in the interest of fairness, [Mostashari] will direct readers to our response on his agency's site," they write.

To learn more:
- here's the commentary
- here's the Blumenthal interview
- read the FierceHealthIT article on Mostashari's initial response to the study

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