EHRs may not be all that after all

The New York Times: “Computerized patient records are unlikely to cut health care costs and may actually encourage doctors to order expensive tests more often, a study published on Monday concludes.

…research published Monday in the Journal Health Affairs found that doctors using computers to track tests, like X-rays and magnetic resonance imaging, ordered far more tests than doctors relying on paper records.

The use of costly image-taking tests has increased sharply in recent years. Many experts contend that electronic health records will help reduce unnecessary and duplicative tests by giving doctors more comprehensive and up-to-date information when making diagnoses.

The study showed, however, that doctors with computerized access to a patient’s previous image results ordered tests on 18 percent of the visits, while those without the tracking technology ordered tests on 12.9 percent of visits. That is a 40 percent higher rate of image testing by doctors using electronic technology instead of paper records.”

I can’t say that I’m surprised by this. I remember something similar when I was working as the night pharmacist at Salinas Valley Memorial Hospital in Salinas, California. Physicians that were using pre-printed order forms to admit patients – now considered the standard of practice – almost always wrote for more PRN medications than those that didn’t use pre-printed order forms. We used to call them “don’t call me orders” because they covered every possible what-if for the patient, i.e. what if they have pain, what if they get a fever, what if they get indigestion or constipation, and so on. And why did they do that? Because it was easy to check a box, that’s why.

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