Researchers fire back on Mostashari for criticism of EHR study

March 14, 2012 in Medical Technology

WASHINGTON – Researchers for a study on the use of electronic health records have issued a response to public criticism they received on the study from Farzad Mostashari, the National Coordinator for Health Information Technology.

At the HIT Policy Committee meeting on March 7, and in a blog post, Mostashari expressed strong disagreement over the study published in the March issue of Health Affairs. The study has drawn a slew of national media attention.

[See also: e-Health records don't always equal reduced costs.]

Authored by Danny McCormick, assistant professor of medicine at Harvard Medical School; David Bor, chief of medicine at Cambridge Health Alliance; and Stephanie Woolhandler and David Himmelstein, both professors at CUNY School of Public Health, the study analyzed 28,741 patient office visits to a nationally representative sample of 1,187 office-based physicians in 2008 – the most current data available, they claim.

The study concluded that doctors who have access to computerized imaging were 40 to 70 percent more likely to order additional tests.

Mostashari said he was frustrated with the researchers’ conclusion, saying it was good for “grabbing headlines,” but not accurate. Mostashari also said the study did not use the correct data to draw conclusions about the use of EHRs.

[See also: Mostashari rankled over HIT survey conclusions.]

In a March 12 blog, published online by Health Affairs, McCormick and his co-authors fired back on Mostashari, saying some of his assertions are mistaken.

“Some take us to task for claims we never made, or for studying only some of the myriad issues relevant to medical computing,” they wrote. “And many reflect wishful thinking regarding health IT; an acceptance of deeply flawed evidence of its benefit, and skepticism about solid data that leads to unwelcome conclusions.”

Earlier this month, Mostashari claimed the researchers failed to take into account the use of decision support and information exchange for reducing costs, available through the use of health IT. He also criticized the use of 2008 data, saying “a lot has changed since then.”

In addition, he said the study also failed to analyze whether the additional testing that physicians ordered was appropriate. “When we talk about health IT reducing healthcare costs, it’s not going to come about by more or fewer lab tests,” Mostashari said.

The researchers said Mostashari’s statement, that reducing test orders is not the way health IT is meant to reduce costs, is surprising – and contradicts statements made by his predecessor at ONC, David Blumenthal, MD.

They add that a Rand study, widely cited by health IT advocates including President Obama, estimated that health IT would save $6.6 billion annually on outpatient imaging and lab testing. Another frequently quoted estimate of HIT-based savings projected annual cost reductions of $8.3 billion on imaging and $8.1 billion on lab testing.

“We focused on electronic access to results because the common understanding of how health IT might decrease test ordering is that it would facilitate retrieval of previous results, avoiding duplicate tests,” said McCormick and his co-authors.

The blog goes on to answer each point Mostashari made against the researchers. The authors said they hoped Mostashari’s critique of their paper would “open a fruitful dialogue.”

Follow Diana Manos on Twitter @DManos_IT_News.

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