The latest issue of Health Affairs (http://content.healthaffairs.org/content/31/3.toc) has brought into question two tenets behind HIT: reducing the number of medical tests and increasing quality based on increased electronic health information.
One article titled: "Computer Access to Test Results Doesn’t Reduce Imaging" finds that allowing doctors easier access to medical imaging tests “was associated with a 40-70 percent greater likelihood of an imaging test being ordered.” The easier it is for a doctor to quickly see the test results, the more likely the person is to order such tests. Arguments have been made to counter the study since it used four year old data and did not take fully into account the role of customized systems that have full electronic records in place and greater incentives for the doctor to stick with previous lab tests and images. But the size of the study involving almost 1,200 physicians divided between those using such computer access and others that do not and the clear distinction in the results between the two groups will prove vexing.
The second article, titled: "Hospital Compare Site Has Little Effect on Death Rates, Study Finds" looks at the CMS program to publically compare hospital performance data. The effort assumes that, once consumers can see and compare hospital performance data there would be pressure on underperforming hospitals to improve outcomes. After looking at claims data for hospitals between eight years, they found little differences in death rates due to heart attacks or pneumonia that could be attributable to publicizing hospital performance. While the report doesn't throw out the need for such information it clearly indicates that the expectations over such an effort are overblown.
These articles add another layer of criticism to earlier reports that electronic records systems actually allow hospitals to increase billings to insurers rather than just cut costs.
Since telemedicine services are based on the transmission of electronic data and images, the establishment of a comprehensive, interoperable and easily accessible electronic health information highway can greatly facilitate the use of remote healthcare. Implementation of electronic records has been slow but recently accelerated thanks to incentive payments CMS is providing to physicians and health systems. It will be interesting to see if these reports inhibit further adoption initiatives.
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