In health care, there is hype and there is reality. Hype is omnipresent, reality sometimes takes a lot of research to prevail. The use of electronic medical records has a lot of reasons to be a good thing. One of the biggest promotions for their use is that they will end up saving on medical spending. The most recent study, while the authors try to put things in the most positive light, demonstrates the unlikelihood that EHRS will aid in reducing overall health spending, even when implemented widely across a specific community. (Annals Article) The researchers tracked 806 ambulatory clinicians who adopted a subsidized EHR and compared spending and utilization for their patients versus a control group. The EHR group was in three communities and resulted in most clinicians in those communities having an EHR. The communities selected as the intervention group received a great deal of support and training for EHR use and implementation, which likely does not reflect the real world. While the researchers attempted to match clinicians and patients in the intervention and support groups, it is unclear how closely they, or more importantly, their patient populations were matched. Notwithstanding all the factors which should have led to a positive outcome, the EHR group showed no significant lower overall spending for their patients. There was a non-significant reduction in outpatient spending, with only a sub-category of ambulatory radiology showing statistically significant decline, a fact likely attributable to the many efforts to reduce imaging use going on during the study period. And this lack of medical spending savings does not take into account the cost of EHR systems and their impact on practice productivity. While the authors and much of the media make every effort to portray this research as demonstrating potential medical spending savings from use of EHRs, the results show nothing of the kind. What should be more important to everyone is whether their use improves quality and health outcomes.
