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Expert Doubts Computer-Based Decision Support Can Control Health Care Costs

Doctors often unaware of financial implications of their decisions (Apr. 16)

In an article published online in the April 15 issue of JAMA Internal Medicine, William M. Tierney, MD, focuses on the potential of electronic medical systems and computer-based decision support to control health care costs.

Tierney is president and CEO of the Regenstrief Institute, a leading medical research organization; associate dean for clinical effectiveness research at the Indiana University School of Medicine; chief of medicine for Wishard-Eskenazi Health; and a practicing physician.

Based on his extensive experience developing and studying electronic medical record systems and clinical decision support systems, Tierney says there is insufficient evidence for claims that these systems may help rein in costs that are spiraling out of control.

“Although doctors generate the vast majority of health care costs, they are often unaware of the costliness of their decisions,” he said. “In a busy practice, doctors focus on their patients’ problems and not on the financial implications of their decisions, which can be enormous. Studies are needed to create and test means of helping doctors deliver the highest quality care at the lowest cost.”

Tierney’s recent essay comments on a study in which doctors were shown the prices of some laboratory tests and not others when using computers to order tests for their patients. When provided with the prices of tests, doctors’ testing costs dropped by almost 9%. However, according to Tierney, the intervention could have inhibited both unnecessary tests and tests that patients truly needed.

“Health care is complex, and physicians order tests for many reasons, some based on rational thinking (e.g. whether the results of a test will improve their treatment decisions), some based on non-rational fears (e.g. missing a highly morbid condition, such as cancer, even if it’s highly unlikely), some based on patient demands and expectations,” he wrote. “Electronic medical record systems and clinical decision support interventions will never alone overcome the costs of unnecessary [medical] testing. But they can help us deal with larger health system and cultural issues.”

“Designing, implementing, and studying computer-based decision support and other electronic health-record-based interventions is difficult and requires collaboration among researchers, clinicians, administrators, and technologists. Without such collaboration, realizing the benefits of electronic health records will continue to be a frustrating illusion to most hospitals and practices,” Tierney observed in his article.

Sources: Indiana University School of Medicine; April 16, 2013; and JAMA Internal Medicine; April 15, 2013.

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