title: Giving office-based physicians electronic access to patients' prior imaging and lab results did not deter ordering of tests.
abstract: Policy-based incentives for health care providers to adopt health information technology are predicated on the assumption that, among other things, electronic access to patient test results and medical records will reduce diagnostic testing and save money. To test the generalizability of findings that support this assumption, we analyzed the records of 28,741 patient visits to a nationally representative sample of 1,187 office-based physicians in 2008. Physicians' access to computerized imaging results (sometimes, but not necessarily, through an electronic health record) was associated with a 40-70 percent greater likelihood of an imaging test being ordered. The electronic availability of lab test results was also associated with ordering of additional blood tests. 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. These findings 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. 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.
authors.affiliation: Harvard Medical School, Boston, MA, USA. DMccormick@challiance.org
authors.forename: Danny
authors.initials: D
authors.lastname: McCormick
authors.forename: David H
authors.initials: DH
authors.lastname: Bor
authors.forename: Stephanie
authors.initials: S
authors.lastname: Woolhandler
authors.forename: David U
authors.initials: DU
authors.lastname: Himmelstein
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002984:Clinical Laboratory Information Systems / Q000706:statistics & numerical data*; D019411:Clinical Laboratory Techniques / Q000706:statistics & numerical data*; D003952:Diagnostic Imaging / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D033181:Information Dissemination / Q000379:methods; D008297:Male; D016347:Medical Records Systems, Computerized / Q000458:organization & administration / Q000706:statistics & numerical data*; D008875:Middle Aged; D009819:Office Visits / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D014481:United States; D055815:Young Adult