Can you really generate a significant medical cost savings by making patient test history available electronically? The answer seems to be a ringing “maybe.”
Two studies from highly prestigious journals seem to have drawn far different conclusions as to how having data available on a patient’s test history affects their propensity to test further. I’d argue that some of the controversy is out of line — that the two tests really seem to be looking at different issues — but controversy there has been.
First, in early March, a paper came out in Health Affairs which concluded that the physicians studied were ordering more tests when they had access to a patient’s previous imaging and blood tests via an EMR. The study found that doctors with access to imaging and lab results online led to a big uptick in new imaging and blood test orders. (Interestingly, the researchers attributed the uptick in part to a “convenience” effect engendered by the EMR — that the doctors would get their results for new tests far more quickly when delivered to them electronically.)
Then, a study came out last week in the Archives of Internal Medicine which found that physicians with HIE access ordered less tests for patients with prior test results than their peers without HIE access. The researchers based their study on data from more than 117,000 patients treated in the HIE-linked outpatient departments of Boston-based Brigham & Women’s and Massachusetts General Hospitals between 1999 and 2004.
So, what do we have here? The Archives study seems to imply that doctors felt they needed less input to treat when they had the tests, while the Health Affairs study suggests that archived patient test data encourages doctors to drill down further.
Honestly, I think we’re looking at two different phenomena here. The first study, as I see it, suggests that doctors are more likely to test when you embed testing orders and results reporting in their workflow, particularly the workflow as they treat known patients. (Improving workflow is largely what EMRs are for, right? Oh wait, different story.)
The HIE study, on the other hand, implies that these networks can do what they’re supposed to do, which is to increase doctors’ understanding of a patient’s baseline or recent problems, cutting down on needless tests.
Honestly, I don’t see the contradiction that others see here. Do you?