A pretty interesting and much discussed article was recently published in Health Affairs by D. Himmelstein and S. Woolhandler.  (see below)

Regards,

Caroline





Health Affairs
March 2012
Giving Office-Based Physicians Electronic Access To Patients? Prior Imaging
And Lab Results Did Not Deter Ordering Of Tests
By Danny McCormick, David H. Bor, Stephanie Woolhandler and David U.
Himmelstein

Abstract

Policy-based incentives for health care providers to adopt health
information technology are predicated on the assumption that, among other
things, electronic access to patient test results and medical records will
reduce diagnostic testing and save money. To test the generalizability of
findings that support this assumption, we analyzed the records of 28,741
patient visits to a nationally representative sample of 1,187 office-based
physicians in 2008. Physicians? access to computerized imaging results
(sometimes, but not necessarily, through an electronic health record) was
associated with a 40?70 percent greater likelihood of an imaging test being
ordered. The electronic availability of lab test results was also
associated with ordering of additional blood tests. The availability of an
electronic health record in itself had no apparent impact on ordering; the
electronic access to test results appears to have been the key. These
findings raise the possibility that, as currently implemented, electronic
access does not decrease test ordering in the office setting and may even
increase it, possibly because of system features that are enticements to
ordering. We conclude that use of these health information technologies,
whatever their other benefits, remains unproven as an effective
cost-control strategy with respect to reducing the ordering of unnecessary
tests.

http://content.healthaffairs.org/content/31/3/488.abstract


Comment: Through the Affordable Care Act and through the Health
Information Technology for Economic and Clinical Health (HITECH) provisions
of the the American Recovery and Reinvestment Act of 2009, Congress wished
to bring under control the ever escalating costs of health care in the
United States. This study of physicians' electronic access to prior imaging
and lab results adds to other data that indicates that the cost containment
measures were merely a wish list that have failed to improve value in our
health care purchasing.

As an another example, a recent report of the Congressional Budget Office
on Medicare's demonstration projects on disease management, care
coordination, and value-based payment revealed that "the evaluations show
that most programs have not reduced Medicare spending: In nearly every
program involving disease management and care coordination, spending was
either unchanged or increased relative to the spending that would have
occurred in the absence of the program."

Instead of simply wishing that these ideas would control costs, we should
adopt policies that we already know are effective. We know that the
financing model of the Affordable Care Act - building on our fragmented
system of private plans and public programs - is the most expensive model
of financing health care, and yet a model that falls far short on
universality, comprehensiveness and equity.

In contrast, single payer and health service models are the least
expensive, and are the most successful in achieving universality,
comprehensiveness and equity. Establishing a health service model through
government takeover of our entire health care delivery system is not a
model that is likely to gain political traction in the foreseeable future.
On the other hand, improving Medicare and converting it into a single payer
national health program is much more consistent with American views of
equity, justice, and choice.

We should certainly encourage the continued evaluation and development of
potentially beneficial measures such as the use of health information
technology. Improvement in quality and efficiency should always be our
goals. But in the overall picture, such efforts would amount to mere tweaks
compared to a comprehensive overhaul of the health care financing system.
Let's move forward with an improved Medicare for all.
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