$30 Billion Cost Conundrum - The Beat of the EHR Drum

Conundrum 1. Word Puzzle, a riddle, especially one with an answer in form of word play. 2. Something confusing, something puzzling, confusing or mysterious.

Dictionary Definition of Conundrum

March 7, 2012 - The political and medical hills are alive with the sound of confusion about whether electronic records save money by eliminating duplication and unnecessary tests and by making medical practices more efficient.

In this case, the conundrum is confusion– a puzzle about what to do about lowering health costs and how to deal with conflicting information about electronic health record (EHR) effects.

Of conundrums, others have said,

• Winston Churchill, “It is a riddle wrapped in a mystery inside an enigma.”

• The Riddler, “It’s a mystery. Broken into a jigsaw puzzle wrapped in an conundrum. Hidden into a Chinese box. A riddle.”

• Danny McCormick, MD, and three co-authors, in the March issue of Health Affairs, after studying EHR effects on 28,741 patient visits to 1187doctors, “Giving office-based physicians electronic access to prior imaging and lab results does not deter ordering of tests.”

The abstract of the article of McCormick and his fellow authors reads:

“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.”

Summary in Plain Language

For those of you who don’t choose to wade through this scientific summary, here’s what it says: electronic health records (EHRs) may encourage doctors to order more tests than doctors using paper records. EHR doctors ordered 40% more tests, and 70% ordered more advanced and expensive imaging procedures such as CT scans and MRIs.

Not What Obama Administration Ordered

These results, of course, are not what the Obama administration had in mind when it allocated $30 billion in its 2009 stimulus plan to develop an ubiquitous interoperative electronic network linking all doctors, hospitals, and patients. The goal was to save $80 billion - the financial figure a RAND corporation study said a universal EHR system would save.

These contradictory findings are confusing. Digital advocates say the study is flawed. Whatever your perspective or your level of disagreement, the results are no laughing matter.

Nevertheless, these findings lend themselves to this word play.

The Beat of the EHR Drum

Those who beat the EHR drum

Find themselves in a conundrum

They claim electronic medicine is an ideal rostrum

From which to preach efficiency as a digital nostrum

For conditions from the rectum to the cerebrum

EHRs display tests digitally across the medical spectrum

With data EHR doctors will do less tests not more of ’em

But alas and unfortunately not all data supports ‘em

What we need is a national referendum,

And a data consensus quorum forum

It all boils down to an argumentum

About meaningful use and EHR momentum

During the political interregnum

Between Obama, Romney or Santorum

Source: Danny McCormack, MD, et. al, "Giving Office-Based Physicians Electronic Access to Patients Prior Imaging and Lab Results Did Not Deter Doctor Ordering of Tests," Health Affairs, March 2012 issue.

Tweet: A study in March issue of Health Affairs indicates doctors with EHRs order more tests and imaging studies than doctors with paper records.