The Impact of Electronic Health Records on Duplicate Testing

The electronic health record (EHR) has been touted as a tool that has the power to improve the quality of patient care; reduce costs; and improve overall efficiency in healthcare. At this year’s American College of Cardiology 62nd Annual Scientific Session and Expo, Hormoz Kianfar, Harmony Leighton, Azriel Avezbadalov, Kunal Buch, and Todd Kerwin of New York Hospital Medical Center of Queens in Flushing, NY, presented information from a study they conducted which focused on the effect EHRs have on duplicate testing.

The EHR has been promoted as the silver bullet to many problems in healthcare for the past decade. In 2005, the RAND Corporation released a report in which they estimated that widespread implementation of EHRs could save the healthcare system more than $80 billion. In 2009, the HITECH Act was enacted to “promote the adoption and meaningful use of health information technology.” (Despite the efforts of the HITECH Act, the fact is that there is still an ongoing discussion as to what constitutes “meaningful use,” and the mere mention of this term to any provider is sure to make them cringe.) More specifically, the implementation of an EHR has been predicted to reduce the ordering of duplicate testing and, in fact, early data performed under highly controlled circumstances somewhat validated this hypothesis. However, the research team sought to test this theory in a real-world setting, and specifically examined the effect of the institution of an EHR on the ordering of duplicate transthoracic echocardiography in a hospital-based laboratory.

In short, the research team evaluated all echocardiograms performed during a 12-month period (July 2007-June 2008) prior to the implementation of an EHR at a 500-bed, urban teaching hospital, and then assessed whether an echocardiogram was repeated within 6 to 12 months of the index study. These results were then compared to the 12-month period after implementation of an EHR. Not only did the team not observe a decrease in the rate of duplicate testing following the implementation of an EHR, but they observed a significant increase. Although the research group admits that there were some limitations in their analysis (did not assess appropriateness, confounders, change in procedural volume over time, etc), they nonetheless feel that their data combined with other recent studies should “promote a more rigorous assessment of the initial claims of the benefits associated with EHR implementation.”