EHR Use Corresponds with larger Rates of Blood and Imaging Tests

Published in the American Journal of Managed Care (AJMC), a recent study discovered that physicians using electronic health records (EHRs) tended to order more CBCs, CT scans, and x-rays for their sufferers in comparison to non-EHR users, calling into question the concept that EHRs could cut costs by assisting providers to reduce repetitious or unimportant testing.  

The research team from the institute of Stanford University and the National Bureau of Economic Research explained, “EHR systems have been federally subsidized since the year of 2009, when the HITECH Act earmarked billions of dollars in reimbursement to early adopters. Proponents described that EHR use would improve care coordination, increase efficiency, expose duplicate testing, and, thereby, decrease costs.”
While preliminary research might have supported this concept, the latest study raises uncertainties that making it easier for providers to order tests via electronic interfaces might increase the number of services prescribed for sufferers.
183,519 patient-provider engagements were examined by the team to evaluate if there was a relationship between EHR access and ordering CBC tests, CT scans, x-rays, and MRIs.
The study found that EHR-enabled physicians are 30% more likely to order their patient a CBC test (complete blood count), 41% more likely to order a CT scan, 37% more likely to order an x-ray, and 23% more likely to order other imaging tests. These results show that EHRs might be working counterintuitively to their ideal intention of increasing care efficiency and recuding the number of tests required for patients.
The study population’s health status involved patients with hypertension (27.4%), hyperlipidemia (16.5%), arthritis (13.4%), diabetes (11.6%), and depression (9.2%). Patients’ common diagnoses included external injury (19.9%), respiratory disease (9.8%), and musculoskeletal disease (9%).
Users working within systems that lack widespread interoperability are more likely to contribute to the issue, the team noted.  
The team applauded few limitations that influence few aspects of the study. The data was drawn from interactions occurring between the time period of 2008 and 2011, and doesn’t involve any data past that point.  Meaningful use came into being in the year of 2012, which has significantly changed the health IT landscape.
Radiologists, anesthesiologists, pathologists and other providers not generally included in primary care practices weren’t part of the data set.  Interactions in large private practices accounted for 92.1% of the study population.  Additionally, the patients surveyed were highly white and privately insured.
While the research does have its limits, the researchers note that the spike in ordering rates indicated some noteworthy features.
They said, “Firstly, we discovered that striking increases in both test and imaging orders for EHR-equipped physicians across almost every subgroup; no variable, from patient demographics to insurance type to comorbidities, eradicated this effect.”
“Second, from the time period of 2008 to 2011—when this data was available—we analyzed that the greatest effect of EHRs on test ordering was in large practice settings, like HMOs, in which individual physicians are least likely to impact institutional IT decisions. In those settings, the argument that doctors who are most likely to adopt EHRs are the same doctors who are most likely to order excessive tests bears less relevance.”
The research team concludes by asserting for a reexamination of the role of EHRs in the quest of healthcare industry to reduce costs and improve value.