• Ibrahim Hakim, Sejal Hathi, Archana Nair, Trishna Narula, and Jay Bhattacharya.
• Stanford School of Medicine, Stanford Graduate School of Business, 291 Campus Dr, Stanford, CA 94305. E-mail: shathi@stanford.edu.
• Am J Manag Care. 2017 Jan 1; 23 (1): e16-e23.

ObjectivesTo determine whether electronic health record (EHR) access influences the number of laboratory and imaging tests ordered, which is a frequently cited mechanism for EHR-enabled cost savings.Study DesignWe analyzed data on non-federally employed office-based physicians from the 2008 to 2012 Electronic Health Medical Records Survey, a supplement to the National Ambulatory Medical Care Survey.MethodsWe estimated logistic regressions to determine the relationship between EHR utilization and the volume of laboratory and imaging tests ordered in our study population, controlling for age, sex, race, clinic type, payer type, health status, comorbidities, and new patients.ResultsPhysicians who actively used an EHR system ordered more complete blood count (CBC) tests than physicians who did not (odds ratio [OR], 1.34; P <.001), even after adjusting for patient demographics, health status, and case mix. EHR-using physicians also ordered more computerized tomography scans (OR, 1.41; P <.001) and x-rays (OR, 1.39; P <.001); the difference for magnetic resonance imaging scans was not significant (OR, 1.08; P = .449). Subgroup analysis highlighted differences in ordering among various patient cohorts.ConclusionsUsing the most recent available nationally representative data, excluding federal and Veterans Affairs' hospitals, we found that physicians with EHR access ordered more tests than their non-EHR counterparts, thus contradicting a common rationale for EHR implementation. We argue that EHR use may actually increase healthcare expenditures by facilitating the ease of ordering tests. Whether these extra tests carry clinical utility requires further analysis.

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