Fun With Studies and Surveys

The NY Times describes yet another case study in dubious scholarship:

Digital Records May Not Cut Health Costs, Study Cautions

By STEVE LOHR

Computerized patient records are unlikely to cut health care costs and may actually encourage doctors to order expensive tests more often, a study published on Monday concludes.

Industry experts have said that electronic health records could generate huge savings — as much as $80 billion a year, according to a RAND Corporation estimate. The promise of cost savings has been a major justification for billions of dollars in federal spending to encourage doctors to embrace digital health records.

But research published Monday in the journal Health Affairs found that doctors using computers to track tests, like X-rays and magnetic resonance imaging, ordered far more tests than doctors relying on paper records.

The use of costly image-taking tests has increased sharply in recent years. Many experts contend that electronic health records will help reduce unnecessary and duplicative tests by giving doctors more comprehensive and up-to-date information when making diagnoses.

The study showed, however, that doctors with computerized access to a patient’s previous image results ordered tests on 18 percent of the visits, while those without the tracking technology ordered tests on 12.9 percent of visits. That is a 40 percent higher rate of image testing by doctors using electronic technology instead of paper records.

I know what you're thinking - since correlation is not causation what was the control sample, the before-and-after technique, or the randomization method employed?  Otherwise, we may have the obvious confounding problem that doctors who like to order tests are also likely to invest in the systems upgrades needed to get on-line access to test results.

One could imagine a study that addressed this.  Maybe the authors found some way to assess random system upgrades so that even doctors who would no more get online than they would get on a donkey still got access to online results, and their usage of tests was monitored.

Or maybe this was a before and after study showing that increased testing followed the installation of the online capability.

Or maybe not:

The research was based on a survey conducted by the National Center for Health Statistics, which collected data from more than 28,000 patient visits to more than 1,100 doctors in 2008.

Unconvincing!  The abstract does not try to be emphatic in its conclusions:

Giving Office-Based Physicians Electronic Access To Patients’ Prior Imaging And Lab Results Did Not Deter Ordering Of Tests

Policy-based incentives for health care providers to adopt health information technology are predicated on the assumption that, among other things, electronic access to patient test results and medical records will reduce diagnostic testing and save money.

...

These findings raise the possibility that, as currently implemented, electronic access does not decrease test ordering in the office setting and may even increase it, possibly because of system features that are enticements to ordering. We conclude that use of these health information technologies, whatever their other benefits, remains unproven as an effective cost-control strategy with respect to reducing the ordering of unnecessary tests.

They conclude that the benefits are unproven.  Bold words.

Eventually we hear from a crtic making this very point:

Dr. David J. Brailer, who was the national coordinator for health information technology in the administration of George W. Bush, said he was unconvinced by the study’s conclusions because they were based on a correlation in the data and were not the result of a controlled test.

Folks with uncanny memories will recall that one of the authors here, David Himmelstein, was a co-author with Elizabeth Warren of some of the advocacy scholarship related to medical bankruptcy that helped make her famous.  No, I don't know what my point is, since this study seems to go off-message by undermining the prospective glories of ObamaCare.

I CONFESS: Folks with uncanny memories will note the Himmelstein/Warren connection, as will people who have been Googling on Elizbeth Warren this morning in contemplation of the Scott Brown Senate race.  Put me in the "Not Uncanny" category.

Comments

[qrstuv]

I work for a place that makes EMR systems. Several years ago, The president of the company said that EMRs are unlikely to reduce costs; he had given it careful thought.

But then came the mandates. We got a lot of business that way.

Thank you, taxpayers!

[maryrose]

Second! Why am I not surprised that more change equals more cost to the consumer.
Voted for Romney and Josh Mandel this morning.

[AliceH]

But but but... the savings from earlier diagnosis of high-cost diseases (like pregnancy) will more than cover the added costs of more and higher-priced tests!

Unrelated, it's a mystery to me why insurance premiums are going up even while more tests are covered as part of mandated preventive aka "wellness" medicine.

While it should be obvious, I'll just point out I'm being sarcastic.

[GMAX]

Ugly day in the market, probably gonna take a whatever shine is left on the Obama Edselvolt...

[NK]

My take-- unless you reform tort laws so that Drs/Hospitals aren't creamed with punitive damages for failing to do tests, Insurance and Hospital Lawyer protocols will manadate the tests be done to avoid giant and inequitable liability. Change the tort laws first, then electronic records will give further marginal cost containment.

[A Casual Observation]

Silly Season is upon us again.

Yesterday on Cavuto, Ann Romney made a quite innocuous comment that the bitchy gossips on MSNBC and on CNN are now spinning into what they call a "gaff". How despicable.

It's kind of like the purpose of alleging that Rush Limbaugh made a gaff, just to change the subject. But with Mrs. Mitt
it was really, REALLY a stretch to misconstrue what she said.

[sbw]

All I know is that the lowest paid "executive" in our health insurance company makes a paltry $200k and the local prez makes $360k. They have 21 different computer systems that don't talk to each other. Prescriptions and tests regularly come up automatically rejected the first time to be approved on second submission. . .

And the reason is that the state won't let other insurers play in our sandbox because they would lose the opportunity (right?) to mandate coverage for things at no traceable cost to them.

Damn politicians.

[daddy]

Good Morning Massachusetts guys.

Insty links this notice that there will be a Memorial Toast to Andrew Breitbart tonight in Boston. Here's the info: Boston Memorial toast to Andrew Breitbart:

J.J. Foley's
21 Kingston St., Boston.
7 pm to 11 pm.

[Jack is Back!]

The Department of "Go Figure": Ran out of my simvastatin cholestorol moderator (very low dose) and it took me 5 days to remind myself to have it refilled. Got them on Sunday. Take one a night before bedtime. So, today went into my Doc for a result of last week's blood sample and find out that my cholestorol has never been better.

So, I told him that that was odd because I haven't been taking the statin for like 5 days until Sunday. He didn't even blink - said the dose is so small its only "cautionary". In other words, it really only keeps the reading where it is and doesn't really lower it or even need to. Still couldn't understand why it is lower now than when I was taking thes statin.

Sometimes I wonder if medicine is a crap shoot if the patient is healthy and has strong vital signs like BP, heart rate, good and bad cholestorl and enjoys a good diet and exercises.

[NK]

sbw @12:35-- that's a very important point-- 1. change tort laws; 2. permit across state line health insurance. 3. electronic records. the state monopolies (effective) for health insurance is ridiculous. let all citizens in every state buy whatever insurance policy they want- more choice is the way-- Obamacare/Singlepayer is the exact wrong approach -- unless you're a grasping power hungry politician as sbw points out.

[Jack is Back!]

Driving back from St. Augustine I was listening to Boortz the Boor but he was on fire regarding Rush and the left and the MFM including CNN. Never heard of this guy Louis C. K. but he is supposed to be some kind of "shock" comedian who has his own show on FX. According to Boortz, Louis C.K. had previousl called Palin a c#@t on twitter and again on some satellite radio show. So why is this relevant to the Rush deal?

For the annual White House Press Corp dinner in which The Won will attend and for which some guy at CNN is chairman of - they are having this guy Louis C. K. be their Wanda Sykes that evening. Here is CNN and the left getting all wee-wee'd up over what Rush said but are crowing Louis C. K. as the master of ceremonies for a Presidential roast.

Kirsten Powers must be shaking her head. I guess they couldn't get that hapless dirt bag Imus instead.

[rse]

I heard Ann Romney's piece and she said she didn't feel rich BECAUSE she has had to deal with both breast cancer and MS. She charmingly made the point that threats to mortality and chronic conditions make you feel like one of the people, not one of the rich.

My sister had a college friend from a famous wealthy family involved in healthcare. All the children had diabetes and mom ended up having a nervous breakdown because they had access to close to perfect information and could afford any procedures. She knew nothing could be done and that's what she couldn't handle. The money made no difference except in how the disabled adults could be taken care of.

Nobody without their health really feels rich.

[Frau Lebensmittel]

Arugula for the masses!

Shoot, it was bad enough with all the social justice and economic inequality and just this week, reproductive justice *carp*--now we get the latest and, perhaps, greatest perceived constitutional flaw: What's missing? Food Justice.

It's an renewed attack on WalMart and it stinks. Yes, welcome the federal food inspectors to do TSA theater work on our food. Yep, this is a great little store; it would be a crime if something happened to it.

[daddy]

Your daily MayBee update:

On a post criticizing Stacy McCain comments about Sandra Fluke, Althouse finally responds to charges she's going to vote for Obama:

["Yep. Althouse is setting up to vote for Obama again."

I do feel repelled from certain Republican. This post is meant to wake up Republicans who are making it too hard for me to stand near them. As I said, they stepped in it and they don't have the sense to wipe off their shoes and walk somewhere better.]

MayBee replies:

["This post is meant to wake up Republicans who are making it too hard for me to stand near them."

Althouse, it is the easiest thing in the world to ignore the Other McCain.

Now, what do you think of President Obama's campaign posting a fake permission slip, telling voters the GOP wants them to have to get permission from their employers to use birth control?]

[glasater]

Anyone live blogging the Idiot in Chief's presser?

[daddy]

Pres on Live. Believe I heard him just say he is going to give away $3,000 free money for refinancing.

Now comes the standard challenge to a delinquent Congress to do what they must do and do it immediately so he doesn't have to go around them.

Now the statement that he is now standing up for home loan protections for the Armed Forces, same guys he just robbed of their Health Care benefits.

Blah.

[daddy]

Now answering questions.

Sez he won't let Iran have a nuclear weapon and that Iran is isolated from the world. Sez he is offering a door for the Iranians to walk thru to rejoin the world community. Sez that's his track record and that he does not like the "casualness" of the repub candidates on the campaign trail talking about war. This is not a game. When I see these folks who have a lot of bluster, a lot of talk.

This from the guy who just 2 days ago said ---"I don't bluff."

Thank goodness Obama doesn't use bluster or talk "casually". or war.

[A Casual Observation]

Ann Romney's innocuous comments showed that she has her head screwed on straight; i.e., she would rather have good health and a family and friends who love her and whom she can love, too, than all of the money in the world.

Members of the MSM have always resented anyone who has real class. Their idea of status is measured by ostentatacious signs of material wealth. That's why they dislike the classy Bushs and why they admire the trashy Kennedys.

[Captain Hate]

Bammy: All that bluster by Repubs about Iran is so different from how I bombed the eff out of Libya.

[daddy]

Tapper asking about any assurances given by Obama to Netanyahu.

Obama sez others should explain the costs of going to war with Iran. Sez he (Obama) is not one of those people who will explain the cost of going to war because I guess he doesn't think he will have to go to war. Sez he won't go into details about Iran or about his asurances to Netanyahu. . Sez again he has opened a door to let the Iranians walk thru to rejoin the world community. That's it. He's a doorman for the Iranian's. Come on in guys and leave your nuke's on the table in the cloakroom.---that's his policy and all you need to know.

Sez 2 times in a row "What I have also said..."

Criticizes "the folks popping off about Iran," and they don't look out for the troops on the ground like he (Obama) does.

[A Casual Observation]

Boortz is an acquired taste. His lecherous
comments about Fox's former news babe Laurie
Dhue were a classic and they were hilarious.
Apparently Ms. Dhue used to work with him in
Atlanta. He must have made her life miserable.

[narciso]

Yes, Captain, Libya was chop chop, whereas Bashir's little chainsaw party, must be monitored constantly, the press is worth than useless, No one asks him, what is the zero barrier, we can't wait for the bomb to be fueled up to attack.

[daddy]

Another question this time asking about what he said 3 years ago and is he surprised that 3 years later we are still in this position?

Responds that the degree of isolation they are feeling from the world Community has made them understand that we mean business. They know what they have to do. This is not a mystery. We will soon have new talks and I don't expect a breakthrough but we should know pretty soon if they take the steps to get in compliance with International norms and mandates and provide the world assurances that they are peaceful.

Gas prices. Sez he wants gas prices lower because they hurt families. And it is not good for the overall economy. "What I have also said ..."
is we must have an overall strategy of increasing production, conservation, and developing clean energy technology---and we have made progress. We will keep on doing all this magic stuff to not hurt consumers. There are bottlenecks in Refineries around the country so we are looking at some short term solutions and I've asked Holder to look at the Oil Speculators. We have to have an overall strategy of reducing our dependence on Oil.

[Captain Hate]

narc Tammy Bruce says that her dental woes yesterday were nothing compared to enduring this presser. And she hopes her sponsors aren't offended.

[Porchlight]

I do feel repelled from certain Republican. This post is meant to wake up Republicans who are making it too hard for me to stand near them. As I said, they stepped in it and they don't have the sense to wipe off their shoes and walk somewhere better.

Did Althouse really write that? That reads like parody.

This is the kind of "reasoning" I really dislike - the "I want to vote for you, and the other guy sucks, but you're making it hard for me, so I'm going to continue voting for the other guy." She's looking for a reason to vote for O again, and if she's looking for a reason, she's going to find one.

Is four more years of Obama going to be good for the country, Ann? That is the chief question you should be considering.

[narciso]

Oh it's 'Marathon Man' time, Captain, and this notion even at the NY Post, that Obama is
actually against Iran having the bomb, that's just a 'consensual hallucination'

[daddy]

Is there a Double standard on Rush Limbaugh, on pressure for his sponsors to pull their support, on the sincerity of his apology?

I can't comment on that or the sincerity of his apology.. The remarks have no place in the public discourse. The reason I called Ms Fluke was because I thought about Malia and my other daughter and I wanted them to be able to speak their mind as they get older without being called horrible names for being good citizens. I wanted her parents to know they should be proud of their daughter. We want to send a message to all our young people. We want you engaged in the debate but there is a way to do it without your being demeaned or insulted when you enter the debate.

Question: Is there a war on women?

I think women will decide that for themselves and it won't be driven by the words of 1 radio announcer, but about all the plans for health care, and their kids education, and Dem's have a better story to tell about how everybody is doing their fair share for everybody than the Republicans.

[Threadkiller]

Did I just hear this right?
Trump claims George Will has greasy hair?

Must be true, I heard it on Rush.

[Captain Hate]

I wanted her parents to know they should be proud of their daughter.

Again treating a 30 year old as a child; where are the feminists on this?

[daddy]

Porch,

Althouse did write that:

Here's the link:

The misguided attack on Sandra Fluke continues, displaying irritating ignorance about women law students.

That comment from Ann is at 3/6/12 11:52 AM, about 2/3rds of the way down.

MayBee's latest follow on:

[How can you convince someone who goes looking for Robert Stacey McCain blog posts to find offense, while ignoring the actions of Barack Obama? That's a choice.
People in her comments section have made very reasonable points, as have others on the web. Althouse chooses not to engage in those discussions.

Althouse is quite capable of convincing herself.]

[James D.]

You'd think Zero's own brain would spontaneously combust from having to keep straight all the lies, distortions, evasions, slanders and various other loathsome crap he utters every timer he opens his mouth.

[matt]

It goes far beyond Limbaugh. It is an assault on the First Amendment. The bishops recognized this, and I think that the vitriol against Breitbart and now the Cato Institute shows their real agenda.LUN

[Captain Hate]

Althouse is voting for BOzo; everything she says from now on out is just covering her fat ass.

Damn why did Michele Bachmann submit herself to questioning from the loathsome Piers Morgan? She makes some really bad decisions.

[Jane]

I swear if we lose this election we will never have another republican president. It's all about implementing the Chicago machine in DC. So when was the last time Chicago elected a republican mayor?

[narciso]

Well he does follow the Costanza rule, so there would be no paradox involved,

[Porchlight]

Thanks, daddy. As usual MayBee gets to the heart of the matter with her usual diplomacy.

[daddy]

Obama sez "the incident of the Quran burning disturbs me."

Sez he "will find a mechanism that will convince the Afghan's that their sovereignty is being respected."

Sez the Quran burning is tragic but remember the Pastor in Florida threatened to burn a Quran and that got people upset.

Sez he has tried to set a course of letting our troops know up and down the line what our broader strategy is. When they know that, they get the job done because our troops are wonderful.

Sez we share interests with the Afghans but at times it won't look as smooth as I'd like. but thats kind of the deal internationally on a whole range of issues.

[narciso]

The burning, how about the murder of two American officers, Fahrfegnugen,

[Porchlight]

OT,

Gallup has had Obama averaging about 45-46% in Feb. 2012. He's at 43% today.

Fun trivia: Gallup had Carter at 41% approval in Feb. 1980.

The ginned-up Fluke story doesn't seem to be moving the needle in the desired direction.

[Threadkiller]

Speaking of Trump, has anyone noticed he did not get asked about the BC after Arpaio's presser? He also isn't offering either.

[Chubby]

((Sez that's his track record and that he does not like the "casualness" of the repub candidates on the campaign trail talking about war. This is not a game.))

I'm sure Bush is so very deeply grateful that Obama never once rhetorically meddled with the war effort in his campaign speeches.

[narciso]

And now the rest of the story,

https://twitter.com/#!/SarahPalinUSA

[Extraneus]

The ginned-up Fluke story doesn't seem to be moving the needle in the desired direction.

How could it? All the women who'd fall for it are already his voters.

[Captain Hate]

I'm still speechless that Trump made fun of somebody else's hair.

[Frau Lebensmittel]

Prez.Kool sez: "The remarks (Rush on Fluke) have no place in the public discourse."

Then why does the WH tolerate *encourage* this witch hunt with a petition on its web site?

[AliceH]

I'd like to know what people who do read Althouse like about reading Althouse. Is it just the great comments she triggers?

daddy - love the press conference reporting. thanks!.

[narciso]

True, but it's hard to see that in the echo chamber, yeah that line about 'air raiding
villages' well Abbotabad is a city, so it doesn't count,

[narciso]

Well we thought she had learned her lesson in the battle of Wisconsin, but apparently not.

[NK]

Extraneous @2:09-- that's very true. All of the contraception side shows are classic Axelrod campaign tactics. They won't convince women and younger voters to vote FOR 'Bam-- they are designed to disgust indy Women and Young voters to NOT vote at all. If they don't vote against 'Bam that's good enough for Axelrod.

[Gus]

6 American officers, but Obama calmed the thing down after the first 2 Americans were shot in the back of the head.

as to Althouse. She finds Republicans disturbing. Has she NOTICED LIBTARDS.

Here is how smart Althouse is.
"I don't like bologna sandwiches, so I'm going to have a shit sandwich instead."

[Captain Hate]

narc, even with her witlessness about that she isn't as ultimately irritating to me as Camille "he just surrounds himself with the wrong people" Paglia.

[narciso]

Really, wait what they say about you;

http://www.realclearpolitics.com/video/2012/03/06/romney_im_not_going_to_say_outrageous_things_about_the_president.html

[Extraneus]

Is the Drudge (upper left) pic from the actually press conference? If so, Obama's not looking very good these days.

[Jane]

Has anyone heard anything about turnout today?

[James D.]

Sometimes I wonder if medicine is a crap shoot if the patient is healthy and has strong vital signs like BP, heart rate, good and bad cholestorl and enjoys a good diet and exercises.

Having taken my mother to 4 different doctors and a couple of dozen tests of all varieties in order to try and figure out what was causing her lower back pain; and then going to another three doctors and many more tests to figure out why my wife was having stomach trouble, and never getting a real answer that led to helpful treatment in either case, I'd say that medicine is a crap shoot a lot more often than we'd like to think.

And that winds back to the topic, that the lovely ObamaCare approach of forcing health decisions on people by top-down, bureaucrat-driven mandate, with "experts" who are nothing of the kind making the choices for us, is a horribly stupid and destructive thing.

[daddy]

"The ginned-up Fluke story doesn't seem to be moving the needle in the desired direction."

Unfortunately it worked up here, but that's because Lisa Murkowski is a nebulous Airhead. I think if we got 10 woman to surround her and criticize her for not voting for Ho Chi Minh she'd suddenly decide to vote for Ho Chi Minh.

The encouraging thing to me is that when I post stuff pointing this out in the ADN I am starting to see a number of "likes" (ie liked this comment). We need to see a whole lot more of that, because the Ellie Light's are smartly focused on inundating the comments sections in order to create the meme that the great majority of opinion is as squishy-feely as Lisa's.

[narciso]

That's a 'chicken and egg' question, daddy because people who couldn't bother to remember
whose surname held the seat for 30 years, voted for her, otherwise she is like John Candy's character in Volunteers.

[daddy]

Haven't up her Jane.

Congrat's on being on the Ballot. As a former candidate for US Senate against Lisa Murkowski, I heartily approve:)

Off with the dogs now to vote. Go Newt.

BTW Marlene,

If you pop up. Is it good news or bad news about your independent ex Governor running for Olympia Snowe's seat?

[PaulL]

My local voting joint in Ohio was slow but steady. I chose Romney although I prefer Gingrich because I do not want Santorum.

[Captain Hate]

It was typically light for a primary in my area; and I voted for Noot just because I thought he was best and damn the consequences. I'll support the last man standing in November.

[narciso]

Yes, Beck had on someone who was voting for Romney, because she couldn't forgive Santorum
supporting Specter, but apparently was okay
with Masscare, small condolescence she wanted to vote for Paul. And then Beck's man, Stu had to rub it in, and point out her vote in VA, is inconsequential anyways.

[Captain Hate]

Crazy Uncle was on Laura Ingraham's show. I'm not sure it was on her show or an earlier clip but his "Iran is Israel's problem" statement should clear up the mystery of why his sites and newsletters attract such unique characters.

[Captain Hate]

Question: Compared to other things he's done this is kind of minor but isn't it usually the case that Presidential pressers or speeches aren't done while elections are going on?

[James D.]

Just add it to the long, long list of things other Presidents haven't done, and wouldn't have even thought to do, CH.

[Rick Ballard]

At least the President cleared up the pronunciation question question. It's Fluke as in puke, not Fluke as in schmuck.

[Frau Lebensmittel]

narciso, I wondered the same, but I believe AA has Helen Reddy's "I Am Woman" as her ring tone.

[Threadkiller]

I thought it was Fluke as in inuquity.

[Frau Lebensmittel]

Rick- you take the word of the man who gave us "medical corpseman"? At this point, I'm all fluked out.

Citizen or subject?
Citizen or serf?
Give me the Garden Gnome or give me St. Jane's.