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Does HIT entice docs to order more imaging tests?

by Brendon Nafziger, DOTmed News Associate Editor | March 06, 2012
Advocates of health information technology say it can help make medicine more efficient and thus save the U.S. health system money. But a new study suggests that the ready access to results provided by HIT are correlated with doctors ordering more, not less, imaging and laboratory tests.

In a paper out this month in Health Affairs, researchers with Harvard Medical School and CUNY School of Public Health found having point-of-care access to computerized imaging results, sometimes but not always through an electronic medical record, was linked with a 40 to 70 percent increased likelihood of ordering a scan. Doctors without access ordered about an imaging test in 13 percent of visits, whereas doctors with access did so in 18 percent of visits. For advanced imaging, this gap was higher.

Surgeons were more likely to order tests than primary care doctors, and women were more likely to get basic scans than men (possibly mammograms and ultrasounds), though not advanced imaging.

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Having electronic access to lab rests also was linked with ordering more blood tests, the study said.

"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," wrote the researchers, led by Dr. Danny McCormick, an assistant professor of medicine with Harvard. "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."

The authors say their findings contradict earlier results in part because earlier studies often examined exceptional health care facilities with cutting-edge products, so aren't generalizable to typical practices with "off-the-shelf" software.

However, the study did not examine whether the additional tests were warranted or not, nor did it look at what impact features like clinical decision support software -- which can inform a doctor on the value of an exam before ordering it -- would have on doctors' test-requesting behaviors.

The researchers got their results from a 2008 survey of almost 29,000 patient visits to some 1,200 doctors' offices. Hospital outpatient departments, radiologists, anesthesiologists and pathologists were excluded from the study.

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