The downside of digital medicine

(Nadine Hutton - Bloomberg) There’s a lot of excitement over the rise of electronic health records — and with good reason. Digital record keeping could make it easier for doctors, hospitals and other providers to share patient information and coordinate care. And that, health policy wonks hope, will reduce costs. Providers will be less likely to order a duplicate test, for instance, if they know a doctor has already performed it. One recent study estimated that wide-scale adoption of electronic medical records could save $8.3 billion annually just by reducing use of medical imaging.

That’s the hope, at least. The reality is a bit more complicated: A new study in the journal Health Affairs finds that physicians with access to digital imaging actually tend to order more diagnostic tests, not fewer. And it’s a significant number: A doctor with access to a digital imaging result is 40 to 70 percent more likely to order another diagnostic test. The same effect was found for doctors who got lab results digitally, which was associated with ordering more blood work.

What about digital record-keeping that gets doctors to order additional care? The authors here think it has to do with the immediacy of results. “In borderline situations, substituting a few keystrokes for the sometimes time-consuming task of tracking down results from an imaging facility may tip the balance in favor of ordering a test,” authors Danny McCormick, David Bor, Stephanie Woolhandler and David Himelstein conclude. “This ‘convenience’ effect of computerized access might cancel out the potential decreases in ordering due to reductions in duplicate or unnecessary testing.”

This isn’t to say that electronic medical records are a bad direction for the American health care system: The potential gains in coordination make it hard to find a health policy analyst advocating for doctors sticking with pens and pads. But it does suggest that some of the hoped-for cost savings from going digital might not materialize.