My question for the day is this: Will the Financial Review run the demolition of the questionable study on which that shaky story it picked up from the New York Times yesterday was based?
The US National Co-ordinator for Health IT, Dr Farzad Mostashari, completely shredded the research at a meeting of the Federal Health IT Committee and on the ONC blog. Describing it as a “study that focused on the numbers while ignoring the patients”, he assigned it to the category of studies that fall prey to the classic fallacy of using association to suggest causality.
In a message that could have been addressed directly to the editors of the New York Times and the Financial Review, Mostashari pointed out that “While such interpretations may make for attention-getting media headlines, it’s important to get the facts.”
The study was not about EHRs at all, much less their “meaningful use”.
McCormick’s article considered how physicians react to electronic viewing of imaging results, not EHRs. In fact, when the authors looked at EHR use, they found that “use of an electronic health record system showed no association with test ordering.” Also, the study data were from 2008, before the passage of the HITECH Act and the linking of payment incentives to the meaningful use of EHRs.
Moreover, the authors did not consider clinical decision support, which helps give providers the data tools they need to make appropriate care recommendations and the ability to exchange information electronically. These are two of the most critical features of certified EHRs, which have been shown in multiple well-designed studies to reduce unnecessary and duplicative tests.
He also picked up on one of the points I made yesterday: “Reducing test orders is not the way that health IT is meant to reduce costs. The ultimate impact of EHRs on reducing cost will be through improvements in the co-ordination and quality of care, and the prevention of unnecessary and costly complications and hospitalisations. Providers who are embracing new delivery and payment models such as Accountable Care Organisations and Patient-Centred Medical Homes know that meaningful use of EHRs is a critical foundation for being able to improve quality while reducing cost.”
What troubles me is that this is yet another example of the dangers of institutionalised scepticism that the merchants of doubt have used to defend the tobacco industry, the nuclear power industry, the fossil fuel industry and the big miners. One might expect shock jocks and elements of the Murdoch press to foster this sort of pseudo science, but journals of record like the New York Times and the Financial Review have a responsibility to subject it to intelligent analysis.
Perhaps another letter to the editor might be in order?