NCPA - National Center for Policy Analysis

Computer Access to Patient Test Results Does Not Decrease Cost or Curtail Test Ordering

March 9, 2012

Through the American Recovery and Reinvestment Act of 2009, the federal government dramatically increased expenditures on efforts to expand the use of health information technology in health care facilities nationwide.  An important justification for this substantial fiscal outlay was that the upfront costs would be largely mitigated by lower costs in the long run, realized by a more sleek and efficient health care industry, says Danny McCormick, an assistant professor of medicine at Harvard Medical School, and his coauthors.

  • It was argued that providing physicians with electronic access to prior imaging test results might reduce redundant test ordering, especially for expensive advanced imaging.
  • Additionally, the availability of data from previous examinations would reassure physicians that conditions were stable and did not require additional testing/imaging procedures.
  • Finally, rapid decision support would allow greater oversight regarding the inappropriateness of additional screening.

Despite these three predicted results, which the Obama administration argued would yield substantial savings, an additional factor has all-but reversed the desired effect: because of the convenience and rapid turnaround associated with new information technology systems, physicians have a larger incentive to redo tests.

  • McCormick and his coauthors attempted to quantify this effect by analyzing data from a 2008 National Ambulatory Medical Care Survey of 28,741 patient visits to a nationally representative sample of 1,187 nonfederal physician offices.
  • Their results indicated, among other things, that physicians without electronic access ordered imaging in 12.9 percent of visits, whereas physicians with access ordered imaging in 18.0 percent of visits.
  • In a further study that accounted for patient characteristics, it was found that physicians with access were 44 percent more likely to order basic screening and 103 percent more likely to order advanced screening.

This effect, which the research team found present across the board of patient types and degree of electronic access, was labeled the "convenience effect" by the team.  Information technology enabled faster and easier imaging by physicians, thereby reversing all of the advantages proposed by the Obama administration when it justified the advocacy of health information technology.

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

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