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Meaningful use of electronic health records.

Meaningful Use Of Electronic Health Records Danny McCormick and coauthors (Mar 2012) have launched a useful debate on the value of health information technology. Because few studies on the cost-effectiveness of this technology have been done, we understand that readers and reporters may be receptive to the authors’ message. However, there is an unfortunate and deep disconnect between the question the authors ask and the one they believe they answer. They ask whether physicians with access to computerized images save money by ordering fewer imaging tests. They conclude that electronic health record (EHR) systems—and, by implication, health information technology in general—have not been proven to control costs. The technology is underspecified. Researchers studying health information technology often err in treating it as a black box, uniformly implemented across sites of care. Disparity across products, product versions, settings and configurations, and the workflows developed at different sites creates enormous variance around the most important variable, the intervention. In this case, for example, the study included both systems providing textual reports only and those presenting the images themselves. It is unclear how often physicians used EHRs to view images or reports, and what portion of that content was available electronically. Access to technology does not guarantee its meaningful use. For example, computerized order entry without realtime, evidence-based decision support simply enables test ordering, without providing guidance about duplication or appropriateness. The authors presented no conceptual model to explain why access to digitized images should affect test ordering. In the absence of research hypotheses about what testing is appropriate for specified conditions, how can the directionality of the authors’ results be judged? Evaluating health information technology requires a nuanced understanding and explicit matching of questions and hypotheses to the definition of the systems studied.