Giving Office-Based Physicians Electronic Access To Patients’ Prior Imaging And Lab Results Did Not Deter Ordering Of Tests

Abstract

Policy-based incentives for health care providers to adopt health information technology are predicated on the assumption that, among other things, electronic access to patient test results and medical records will reduce diagnostic testing and save money. To test the generalizability of findings that support this assumption, we analyzed the records of 28,741 patient visits to a nationally representative sample of 1,187 office-based physicians in 2008. Physicians' access to computerized imaging results (sometimes, but not necessarily, through an electronic health record) was associated with a 40-70 percent greater likelihood of an imaging test being ordered. The electronic availability of lab test results was also associated with ordering of additional blood tests. The availability of an electronic health record in itself had no apparent impact on ordering; the electronic access to test results appears to have been the key. These findings raise the possibility that, as currently implemented, electronic access does not decrease test ordering in the office setting and may even increase it, possibly because of system features that are enticements to ordering. We conclude that use of these health information technologies, whatever their other benefits, remains unproven as an effective cost-control strategy with respect to reducing the ordering of unnecessary tests.H ealth policy experts, consultants, policy makers, and the Obama administration have argued that widespread adoption of health information technology will result in substantial cost savings. Reduced ordering of imaging and other diagnostic studies is often cited as a likely mechanism for cost savings related to health information technology. The use of imaging studies-particularly advanced imaging, or computerized tomography scans, positron emission tomography, and magnetic resonance imaging-has escalated dramatically. 8 In 2002 it accounted for more than 14 percent of Medicare Part B expenditures. 9Health information technology might be expected to decrease the use of diagnostic imaging in several ways. Providing physicians with electronic access to prior imaging test results might reduce redundant test ordering, especially for expensive advanced imaging. Even in the absence of prior imaging, the improved availability of data from previous physical examinations and diagnoses might reassure clinicians that a cur-

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Yelp for Prescribers: A Quasi-Experimental Study of Providing Antibiotic Cost Data and Prescription of High-Cost Antibiotics in an Academic and Tertiary Care Hospital

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