Mostashari ‘sets record straight’ on EHR criticism

Kicking off the 33rd meeting of the federal Health IT Policy Committee on March 7, Farzad Mostashari, M.D., national coordinator for health IT, was eager to address a study published in the March issue of Health Affairs that questioned whether investment in health information technology would lead to cost savings.

Mostashari told the assembled audience that the only thing the study found was that clinicians with systems that let them view images ordered more images. “It is not a particularly surprising observation,” he said. What’s surprising, he added, is the conclusion that asks whether the federal government’s multibillion-dollar effort to promote health IT may not yield anticipated cost savings. Indeed, it suggests that it is possible that computerization will drive costs up, not down. “The interpretation obviously helps to grab some headlines,” he said.

But Mostashari added that he wanted to “set the record straight” on what the study actually found and what it actually did. The study was not about EHRs, much less about meaningful use of EHRs, he noted. He said the data was from 2008, and added that a lot has changed since then. The study didn't consider some of the aspects of meaningful use of EHRs, including decision support and information exchange, he added. He said that as an epidemiologist, he was surprised by the causality assigned by the study’s conclusions. “It could well be that ordering more tests leads to buying imaging systems, not the other way around,” he said.

He went on to say that this was an observational study that wasn't designed to answer questions about costs or about the relationship between EHRs and quality. It didn’t take into account factors such as the level of acuity of illness, physician training, the practice of defensive medicine and financial arrangements. From a clinical and patient point of view, the study didn’t answer questions about the appropriateness of the tests that were ordered.

“Finally, when we talk about health IT being the foundation for improving quality and safety and reducing costs, it is not going to come about by people ordering more or fewer lab tests,” Mostashari said. “The big savings are in improvements in coordination of care, and reducing unnecessary and harmful complications and hospitalizations.” Providers who are embracing new delivery systems such as accountable care organizations and patient-centered medical homes know they can’t succeed without health IT tools, he said.

“Despite the power of anecdote and headlines making an impact on our consciousness, we have to be careful to look at evidence systematically and not anecdotally,” he said.

A systematic review of the evidence shows that EHRs have the ability to give providers the tools and power they need to effectively improve quality and reduce costs, he said. “So this is one study, and it is a brief flurry of interest in the larger question. Yes we are succeeding in making progress on health IT. That part is no longer in question,” he said. “Appropriately, the conversation is now focused on what do we make of that progress. How will we as a country—providers and hospitals and vendors and academics and patients—use the progress? And that is where as least as great a challenge lies for us, in the effective use of these tools.”

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