So Maybe HIT Won’t Save Lots of Money?

While it relates to only one small area of functionality, a recent study published in Health Affairs should give pause to those who continue to say that widespread use of health information technology will reduce health spending.   (HA Article)   The study looked at imaging and blood test ordering in practice settings where an electronic medical record allowed easy ordering and viewing of test results.  The prevailing theory has been that giving doctors such capabilities would have the effect of avoiding redundant and unnecessary testing and the reform law projections included several billion dollars annually in savings from reduced imaging and lab testing.  The authors of this study used data from the 2008 National Ambulatory Medical Care Survey to test the association between health information technology use and imaging and testing, and they adjusted for a wide variety of patient and practice characteristics.   Depending on the type of analysis used, the researchers discovered that not only was greater availability of HIT not associated with less imaging or blood testing, it actually appeared to be related to higher use.  In fact, there appeared to be as much or 40%or 50% more likelihood of an order when the physician had an electronic ordering and results system.

Possible explanations for the results, according to the researchers, include that the ease of ordering and result review given by an electronic system creates a convenience factor that lessens the anticipated burden of ordering a test.  It is also possible that physicians who are more inclined to have a electronic records system are also more inclined to order tests.  It may also be that most of these systems do not have extensive decision support that provides guidelines to limit inappropriate test ordering.  Some facilities have shown reductions with such decision support.  But this study clearly suggests that not only may great use of health information technology not create medical cost savings, but the use of that technology itself is an additive cost to health care.  Also contrary to what many project, HIT raises administrative costs for medical practices.  Now it should be noted that the technology may improve quality, although the research is mixed on that as well, and improving the health status and health outcomes of patients should always be the foremost objective of the health care system.