Physicians with regular electronic access to X-rays, CT scans and MRIs are 40 percent to 70 percent more likely to order those kinds of tests than physicians without electronic access, according to a study(content.healthaffairs.org) (abstract) in the March Health Affairs.
The findings challenge a prevailing theory that electronic access to patient test results will reduce diagnostic testing, thereby saving money. "Reduced ordering of imaging and other diagnostic studies is often cited as a likely mechanism for cost savings related to health information technology," say the authors of the article.
However, the study's finding "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," according to the authors. "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."
The authors point out, however, that "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."
The study, which was conducted by researchers at the Cambridge Health Alliance in Massachusetts and the City University of New York, looked at data from the 2008 National Ambulatory Medical Care Survey of 28,741 patient visits to 1,187 office-based physicians. Information gathered included the type of physician, the level of office computerization, and the type and number of tests ordered by each office. Roughly half of the physicians had computerized access to test results.
The study authors note that they found no evidence that electronic access to imaging or blood test results led to fewer physician orders for these patient services. In fact, say the authors, the reverse may be true. "Facilitating physicians' access to test results through computerization may increase diagnostic image ordering."
One explanation they give for their findings is that electronic access, particularly to diagnostic imaging tests, may make it so easy for physicians to retrieve the results that it provides indirect encouragement to order more tests. "In borderline situations, substituting a few keystrokes for the sometimes time-consuming task of tracking down results from an imaging facility may tip the balance in favor of ordering a test," say the authors.
The study also found that
- surgeons and other subspecialists were more likely to order imaging tests than primary care physicians;
- physicians without electronic access ordered imaging tests in 12.9 percent of visits, while physicians with electronic access ordered imaging in 18 percent of visits; and
- women received more imaging studies overall than men, which likely reflects their use of mammograms and ultrasound studies, but they did not necessarily receive more advanced imaging studies.