Does EHR Use Prompt Over-Ordering of Tests?

A study published in the journal Health Affairs last month that suggests EHRs - and physicians who use them - are to blame for ordering too many tests is stirring up some controversy. 

The study, “Giving Office-Based Physicians Electronic Access to Patients’ Prior Imaging and Lab Results Did Not Deter Ordering of Tests,” cites a 40 to 70 percent increase in testing among doctors with computerized access to test results (sometimes, but not necessarily, through an EHR). Additionally, researchers who authored the study, based on analysis of 1,187 office-based physicians in 2008, said findings “raise the possibility” that 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.

“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,” researchers stated.

However, critics of the study are concerned it could cast doubt on long-held beliefs about health information technology's (HIT) potential to decrease healthcare spending and inefficiency. 

Jordan Battani, managing director for CSC’s Global Institute for Emerging Practices, said she takes issue with the report for a few reasons.

“That study particularly wasn’t a controlled study, so it didn’t look at physician behavior before and after use of electronic medical records,” Battani told Physicians Practice. “It just compared physicians with EHRs to physicians without EHRS … those physicians ordering lab tests might have had that pattern of ordering lab tests before.” 

That being said, Battani noted that duplication of testing is a pretty significant contributor of healthcare costs. Using EHRS and being part of a health information exchange (HIE), which better allows physicians to see a patient’s medical history (including tests ordered), may actually help solve this problem. 

“Get yourself hooked up to information exchange as quickly as you can,” said Battani. “I think physicians would be happy to know what is happening to their patients. What they want is to eliminate unnecessary and duplicate efforts.”