Why electronic medical records may not save money

Why electronic medical records may not save moneyA recent study from Health Affairs has been generating some buzz, as well as passionate rebuttals.

According to the study, doctors who used electronic medical records actually ordered more tests, compared to those who used paper records.

There was a 40% increase in ordering imaging tests, a number that increased to a whopping 70% when it came to advanced tests, like MRIs or CT scans.

According the the study’s lead author, “Our research raises real concerns about whether health information technology is going to be the answer to reducing costs.”

The findings have generated controversy, with critics pointing to flawed methods and old data.

Despite who’s right, whether electronic medical records truly save money is seriously in question.

The study didn’t offer any reasons why doctors ordered more tests, but speculated it was because it was simply easier. What used to take pen and paper to order now takes a mouse click or two.

The findings don’t surprise me. Aside from large integrated systems, like Kaiser Permanente in California and the Veteran’s Administration, most physician practices adopt different EMRs. And in many cases they don’t talk to one another. So, a physician’s record may not able to able to access notes from his local hospital if they used different systems. Some doctors in that situation may simply re-order a test, rather than go through the time of obtaining the records from the hospital.

The true power of digital records come when using a single, unified system that can be accessed by different health venues. With the exception of large integrated health systems, we have mostly have a mess of siloed, fragmented EMRs.

Perhaps with the consolidation health reform is instigating, more doctors will be able to practice under a unified EMR, which then would realize more cost savings. But until that happens, EMR evangelists who promise lower costs may find their expectations cut drastically short. The technology simply isn’t there yet.

 is an internal medicine physician and on the Board of Contributors at USA Today.  He is founder and editor of KevinMD.com, also on FacebookTwitterGoogle+, and LinkedIn.

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  • Anonymous

    And there is the problem of, if the EMR working, that it is a garbage in, garbage out system.  If you have one doctor take a bad history and record you as having, for example, a cardiac issue that you do not have, it will be propagated hither thither and yon, such that you will never get rid of it, in each instance having unnecessary tests ordered and medications administered for the fictitious disease that you do not have. And since no doctor would actually believe a patient and there is no way to correct a medical record …..

  • http://www.facebook.com/people/Steven-Reznick/100000549195050 Steven Reznick

    The implementation of a EMR system in my office has been long and painful due to the lack of customer service by our large well established nationally known vendor. That being the case, I am convinced the different systems will link up by 2015 and make practicing much easier for us all. ARRA 2009 is a disaster putting the burden of implementation and meeting meaningful use on the doctors not the suppliers. If the suppliers and vendors didnt get paid until our offices and hospitals were well trained and met meaningful use we would be seeing outstanding trainers supplied by the suppliers and vendors accompanied with responsive, courteous and helpful call centers when we have questions and problems. Once again the legislators who passed this law and our advocacy groups pushing for it were short sighted and wrong.

    • http://www.facebook.com/profile.php?id=558041620 Vikas Desai

      It is a situation such as this is why I feel for early adopters. There is too much disarray and too many non-physician hands in the cookie jar with questionable motives. EMR’s are just like any other piece of tech, in 5 years tech becomes obsolete. 

    • Anonymous

      That’s an excellent point, and is too often overlooked.  The lawmakers are essentially being bought by EMR vendors – just google “obama allscripts” and that quickly becomes clear.

  • http://onhealthtech.blogspot.com Margalit Gur-Arie

    Just a tiny correction here, the presence of the EMR itself and the ability to easily order tests was not correlated with higher rates of image orders. It was those physicians that had software allowing them to actually view the results that ordered more. Perhaps because of the improved utility, perhaps not.

    There is however one overlooked result evident in their data set and that is that hospital employed doctors ordered a lot more tests than anybody else and solo practitioners ordered, by far, the least number of expensive imaging studies. Perhaps consolidation doesn’t bode well for this particular aspect.

    The authors response to rebuttals is here http://healthaffairs.org/blog/2012/03/12/the-effect-of-physicians-electronic-access-to-tests-a-response-to-farzad-mostashari/ and it links to both the original study and the fiercest rebuttal.
    We need much more research.

  • Anonymous

    EMRs are a supply side tool and are designed to provoke more care and more tests as desired by the large systems that are implementing them. Chronic disease management prompts and “decision support tools” are designed to increase testing and prescribing. The outrageous cost of these systems is only the edge of a gigantic hole siphoning health care dollars away from real patient care. Then there will be the never ending series of upgrades, then more chasing “meaningful use”, then the inevitable slide into obsolescence that all technologies encounter…ooops, it’s time to get a new system…again. Needless to mention: the very expensive practice of utilizing physicians as data entry and mining drones. We definitely need more research on this topic before we dig the hole even deeper.

  • http://www.facebook.com/profile.php?id=558041620 Vikas Desai

    EMR can save money and be more effecient, but in its current form where different types of info cannot talk to each other and voice recognition tech is not perfected and the scanner is of utmost importance to an absurd degree. I would love to start EMR and just dictate my notes in real time. Its getting there but the problem is that you have too many small entities selling clueless MD’s questionable software and rapidly obsolete yet expensive equipment. Free web based practice fusion seems to be the best bet, plus I personally feel MD’s should not be left on the financial hook for protection of data, not when practices can barely stay afloat without overbooking understaffing or overutilizing their own testing equipment

    • Anonymous

      Yes, why are physicians on the hook for data protection? The Pentagon can’t even keep its data from leaking out. Microsoft has yet to figure it out despite years of trying. Unless something miraculous happens, using “EMR” and “safe” in the same sentence will be difficult.

  • http://www.facebook.com/profile.php?id=558041620 Vikas Desai

    I also feel to reduce this level of testing, these ridiculous “drop down”  menus need to be eliminated, Medicine is ever an art, the best docs always improvise, most old fogie MD’s who can’t type end staring at the computer spending 45 minutes completing a note, for them and the rest of us, high level voice recognition is the way to go, where the MD’s plan is clearly delineated and it should not be linked to ordering tests or connected to the billing, having all your eggs in one basket is a recipe for disaster

  • Anonymous

    Our health care system has as its primary goal maximizing corporate profits. If EMRs are being designed and used to accomplish that goal, how can we be surprised?

    • mark singh

       What successful venture do you know that does not try to maximize profits?  For example, do you trust your life flying in a “for profit” airline? I would hope our health care system does allow for maximizing corporate profits. Only than can we expect the best technology, knowledge and expertise that we have come to expect from our system. Profit and self interest are the greatest motivators and have resulted in the greatest advancements in history. Find me some examples where it is not.

  • Anonymous

    Hello all,
    The EMR issue is a neverending story, so far. WHy in our super standardized world are there different electrical systems or different Color TV systems as well? Just because…One of the big advantages of teh EMRs is that they generally prevent missunderstandings generated by the traditional “doctor’s handwriting”. Another advantage is that you are helped by  POP ON window when you write by mistake an appropriate med dose ar when you want to find out in an instant some details about an unfamilliar symptom or desease. The time is not lost. We have a long, captivating and challenging way ahead of us: chosing the best EMR system (if there is such a thing as “the best”) or some computer translator program that would make the different EMR systems talk between them. Don’t give up, the solution is out there!
    Paul, Israel

  • Iddlebiddle

    Most patients never wanted this system.  Many of those who were computer literate also realized that most doctors would never realize that virtually any computer system is hackable whether going through the Internet or not.  These systems are not only expensive but will continue to be expensive with regard to repairs, upgrades, viruses, changes, hackers and so on.  In fact, they chew up so much money that there is almost none left to treat patients.

    I would love to see the entire thing destroyed permanently, and go back to the days when a doctor would look the patient in the eye to communicate, versus staring at his computer for most of the five  minutes he is with his patients.  This system gives patients the impression that doctors are ice cold zombies, so naive about the dangers of putting things on computers that they are as much of a threat to patients as a cure.  And I’m not even mentioning the BILLIONS of medical records that have already been lost and stolen due to outright and continuing carelessness with regard to leaving disk drives and laptops lying around or in cars while a doctor goes somewhere for five minutes with a thief somehow nearly always in the area by strange coincidence, or files being unencrypted more often than encrypted.  Wanna bet that most of those patient files have landed in the hands of medical insurance agencies and government?

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