We all know electronic health records are supposed to lower healthcare costs. The technology improves efficiency and puts the information doctors need to make smarter decisions right at their finger tips. This leads to less unnecessary spending, right?
Not so, says a study published in the latest issue of Health Affairs. In this investigation, researchers found that physicians who have electronic access to patients’ test results are significantly more likely to order lab tests and imaging tests. The findings were based on a review of nearly 30,000 medical records.
The results of the study led the researchers to conclude that the cost-controlling ability of EHRs and health IT in general remains unproven. This should call into question efforts on the part of the federal government and other payers to encourage the use of these tools.
So much for lower costs through EHR use. The technology certainly has been trumpeted as a potential game changer for the healthcare system. Most experts have concluded that creating a fully-networked delivery system will result in better care coordination and lower costs. If this is not the case, much of what has been planned by public and private healthcare groups for the future of the industry may require revision. So do the findings really mean the sky is falling?
Perhaps. But then again there are reasons to eye the findings with suspicion. First of all, the results come from an observational study, rather than a randomized controlled investigation. This means it is difficult to prove what came first, the EHR use or the physicians’ propensity to order tests. Second, all of the data come from records generated in 2008, well before the advent of the meaningful use program and the maturation of the EHR industry. All of this was pointed out in a recent blog post by national coordinator for health IT Farzad Mostashari.
And of course, numerous other studies have surfaced in recent years pointing to the ability of EHRs to lower costs. Furthermore, there is growing consensus that the technology improves quality, which may lower costs in a number of ways, such reducing hospital readmissions, improving chronic disease care and minimizing physicians’ malpractice risk. These are all questions that the present investigation failed to take into consideration.
However, there are some indications that suggest the case for EHRs lowering costs is not necessarily closed. For example, ever since the meaningful use program launched some physicians have complained that the regulations were too burdensome and that the technology is too difficult to use. This can affect efficiency and limit the number of patients doctors are able to see in a day, which in turn may force physicians to charge more for each encounter.
There is also the cost of systems to consider. The meaningful use program is meant to defray some of this expense, but depending on the size of a practice and the availability of IT resources, the incentive payments may not be enough to cover the cost of a new EHR.
Ultimately, my sense is that time will be the only true judge of whether or not EHRs make a meaningful dent in healthcare costs. Don’t forget, the technology is still relatively new to most physicians. It may take time before the entire healthcare industry is up to speed and using EHRs optimally. In the short term, some doctors may struggle to maintain their workflow and control costs while transitioning to a new system. But there appears to be too much evidence suggesting EHRs will eventually improve efficiency and lower costs to call off efforts to get more doctors using the technology.
At least, there is too much evidence to be persuaded that EHRs lead to higher costs by a single study.