Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Doubting the cost savings of health information technology

Jennifer Shine Dyer, MD, MPH
Tech
March 31, 2012
Share
Tweet
Share

A recent Health Affairs article casts doubt on the cost-saving prospects of health information technology despite the significant investments made by hospitals, physicians, and the federal government to promote electronic records.

Reduced ordering of imaging and other diagnostic studies by physicians is often cited as a likely mechanism for estimated cost savings due to health information technology. Possible mechanisms include reduction in redundant (duplicated) tests secondary to better access to information or due to point-of-order decision support that helps providers  rethink the appropriateness of testing. However, these mechanisms and the purported savings are merely assumptions.

Harvard researchers assessed a large outpatient data set to evaluate the hypothesis that health IT (computerized availability of imaging or use of full EMR) reduces image test ordering. The study design was that of an observational cross-sectional survey. The primary outcome variable, or dependent variable, was the presence or absence of physician-ordered imaging (CT, MRI, any radiology imaging). The predictor variable, or independent variable, was the availability of computerized reporting of test results.

The data were derived from the National Ambulatory Medical Survey which was collected in 2008 (prior to the passage of the 2009 HITECH legislation that dramatically expanded federal financial incentives for adoption of health IT). The data include a nationally representative sample with 28,742 patient visits to 1,187 physicians scattered across the United States. Multivariate logistic regression modeling was performed to account for multiple confounding variables that affect a physician’s decision process to order imaging tests: computerized order entry, physician specialty (excluded orthopedics, neurology, cardiology which order disproportionately more imaging tests), physician affinity for technology, physician financial incentives, physician practice business profiles (owner or employee/contractor, prepaid practices, hospital-owned practices, solo practitioner, urban), and also patient factors (age, sex, ethnicity, insurance type, residence in poverty-level zip code, whether seen by physician before, and presence of chronic diseases: diabetes, heart disease, cerebrovascular disease, cancer). Patient outcomes, disease acuity, and ICD-9 disease-specific reasons for the images ordered were not measured. Additionally, whether or not specific images were duplicated in an individual patient was not measured.

Overall, the prevalence of imaging orders by physicians with computerized systems for accessing imaging results was 40-70 percent higher than without computerized systems. Of the 28,741 physician visits, 4,335 resulted in an order for imaging. Computerized systems for accessing imaging results were available for 13,401 visits (in 6,458 the actual images were viewable). Computerized order entry did not affect the likelihood of image ordering. Patient and physician practice characteristics were not associated with likelihood of image ordering. Physician affinity for technology and physician financial incentives did not change the likelihood of image ordering.

Commentary

Computerized order entry did not affect the likelihood of image ordering but access to computerized imaging results was associated with increased rather than decreased image ordering. However, the original assumption of the effect of health IT on reducing unnecessary imaging duplication was not evaluated; duplicate imaging per patient was not actually measured. It is the duplication of imaging per patient that is most likely the culprit for wasteful spending rather than the total orders of images within a health care system.

Several important factors that affect a physician’s decision to order images in the first place were not addressed: disease acuity, disconnected health IT systems, and defensive medicine.

Perhaps a better research question: does health IT reduce the duplication of image ordering in a population with matched disease acuity?

Researchers should also investigate how disconnected health IT systems (even within a single hospital) might affect image ordering duplication. For example, although a chest X-ray might have been ordered in the emergency department (ED), an inpatient physician without access to the ED health IT system may order another chest X-ray on hospital day 1 so as to have a desired clinical baseline for comparison. In this scenario, connected health IT systems within one hospital (not to mention across myriad sites of care) could likely reduce unnecessary duplication of imaging. For example, the inpatient physician could be liable in a malpractice case if the original ED X-ray could not be accessed or evaluated. Thus, the unnecessary duplication of a baseline X-ray is done only to prove that it was evaluated by the inpatient physician. This provides protection in the mind of the physician worried about liability and likely drives the escalating costs of defensive medicine.

Perhaps it is not enough just to have a health IT system but rather it is the quality of connectivity between health IT systems (coupled with a less litigious environment) that produces the anticipated cost-saving advantages of health IT and the true effects on physician behavior?

Jennifer Shine Dyer, a pediatric endrocrinologist, is Founder, EndoGoddess LLC and Chief Medical Advisor, Eproximiti DuetHealth.com. She blogs at EndoGoddess Musings and Policy Prescriptions.

Submit a guest post and be heard on social media’s leading physician voice.

Prev

Why full code should not be the default status for patients

March 30, 2012 Kevin 11
…
Next

When patients are my greatest teachers

March 31, 2012 Kevin 4
…

ADVERTISEMENT

Tagged as: Health IT

Post navigation

< Previous Post
Why full code should not be the default status for patients
Next Post >
When patients are my greatest teachers

ADVERTISEMENT

More by Jennifer Shine Dyer, MD, MPH

  • a desk with keyboard and ipad with the kevinmd logo

    Get doctors and patients involved in health startups

    Jennifer Shine Dyer, MD, MPH
  • a desk with keyboard and ipad with the kevinmd logo

    Physicians aren’t taking mobile health seriously

    Jennifer Shine Dyer, MD, MPH

More in Tech

  • AI is already replacing doctors—just not how you think

    Bhargav Raman, MD, MBA
  • A mind to guide the machine: Why physicians must help shape artificial intelligence in medicine

    Shanice Spence-Miller, MD
  • How digital tools are reshaping the doctor-patient relationship

    Vineet Vishwanath
  • The promise and perils of AI in health care: Why we need better testing standards

    Max Rollwage, PhD
  • 3 tips for using AI medical scribes to save time charting

    Erica Dorn, FNP
  • Would The Pitts’ Dr. Robby Robinavitch welcome a new colleague? Yes. Especially if their initials were AI.

    Gabe Jones, MBA
  • Most Popular

  • Past Week

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Why timing, not surgery, determines patient survival

      Michael Karch, MD | Conditions
    • Why health care leaders fail at execution—and how to fix it

      Dave Cummings, RN | Policy
    • How digital tools are reshaping the doctor-patient relationship

      Vineet Vishwanath | Tech
  • Past 6 Months

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • The hidden health risks in the One Big Beautiful Bill Act

      Trevor Lyford, MPH | Policy
  • Recent Posts

    • Why ADHD in women requires a new approach [PODCAST]

      The Podcast by KevinMD | Podcast
    • AI is already replacing doctors—just not how you think

      Bhargav Raman, MD, MBA | Tech
    • Why doctors must stop ignoring unintentional weight loss in patients with obesity

      Samantha Malley, FNP-C | Conditions
    • Why more doctors are choosing direct care over traditional health care

      Grace Torres-Hodges, DPM, MBA | Physician
    • Why hospitals are quietly capping top doctors’ pay

      Dennis Hursh, Esq | Conditions
    • Why point-of-care ultrasound belongs in emergency department triage

      Resa E. Lewiss, MD and Courtney M. Smalley, MD | Conditions

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 11 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Why timing, not surgery, determines patient survival

      Michael Karch, MD | Conditions
    • Why health care leaders fail at execution—and how to fix it

      Dave Cummings, RN | Policy
    • How digital tools are reshaping the doctor-patient relationship

      Vineet Vishwanath | Tech
  • Past 6 Months

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • The hidden health risks in the One Big Beautiful Bill Act

      Trevor Lyford, MPH | Policy
  • Recent Posts

    • Why ADHD in women requires a new approach [PODCAST]

      The Podcast by KevinMD | Podcast
    • AI is already replacing doctors—just not how you think

      Bhargav Raman, MD, MBA | Tech
    • Why doctors must stop ignoring unintentional weight loss in patients with obesity

      Samantha Malley, FNP-C | Conditions
    • Why more doctors are choosing direct care over traditional health care

      Grace Torres-Hodges, DPM, MBA | Physician
    • Why hospitals are quietly capping top doctors’ pay

      Dennis Hursh, Esq | Conditions
    • Why point-of-care ultrasound belongs in emergency department triage

      Resa E. Lewiss, MD and Courtney M. Smalley, MD | Conditions

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Doubting the cost savings of health information technology
11 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...