Blog | Wednesday, March 7, 2012

QD: News Every Day--When presented with scans, doctors still order more tests

Electronic access to test results does not stop doctors from ordering more tests and may even increase the rate, because of system features that entice more ordering.

Pay incentives for health care providers to adopt health information technology are based on the assumption that electronic access to patient test results and medical records will reduce subsequent testing and save money.

To test the assumption, researchers analyzed records from the 2008 National Ambulatory Medical Care Survey of 28,741 patient visits to 1,187 office-based physicians. The survey excludes hospital outpatient departments and offices of radiologists, anesthesiologists and pathologists. Results appeared in the March issue of Health Affairs.

Physicians' access to computerized imaging results (not necessarily through an electronic health record) was associated with a 40 to 70% greater likelihood of an imaging test being ordered. The electronic availability of lab test results was also associated with ordering of additional blood tests. It wasn't the electronic health record, which had no impact; it was associated with electronic access to test results.

--Physicians without access ordered imaging in 12.9% of visits, while physicians with access ordered imaging in 18% of visits.
--Women received more imaging studies overall than men, perhaps reflecting mammograms and ultrasound studies, but not more advanced imaging.
--Surgeons and other specialists were more likely to order imaging tests than primary care physicians.

The findings challenge the assumption that computerization decreases test ordering and health care costs in outpatient medical care, the authors said.

"As with many other things, if you make things easier to do, people will do them more often," the lead author noted.

Computer access to medical records has been estimated in some studies to potentially save $8.3 billion a year on imaging and lab testing. But the authors noted this figure is based on a few large health care providers with cutting-edge systems. It isn't generalizable to the typical office, where more bare-bones systems are cumbersome to use, are not interoperable, or lack effective decision-support software. Even hospital-owned practices with the highest levels of interoperability and decision support had high rates of ordering tests.