Journalist Laura Newman, on her Patient POV blog, posts, “MR Imaging, Electronic Test Ordering Creates Waste.”
Waste is what you get with rampant, uncritical use of MRI and health information technology, according to two papers out this week. The authors of a companion editorial to one of the papers even go so far as to suggest we should make waste a quality of care measure. I applaud them.
She notes that authors of one of the papers acknowledge “that imaging is a fundamental part of acute stroke evaluation and that it is more accurate than computed tomography (CT) for stroke diagnosis. However, they also point out that no data has shown that stroke patients undergoing MRI do any better than those who do not.”
In the other paper she writes about, the authors “challenge the contemporary mantra that health information technology will cure so many ills in our healthcare system. Here, they demonstrate how the ease of access to electronic test results led to a 40% to 70% jump in ordering imaging studies. when doctors had access to computerized imaging. They argue electronic access to test results alone may offer enticements to additional ordering.”
Together, these papers shine a light on how easy it is to order imaging tests and how imaging is the gee-whiz technology of our age. If we really ever get serious about waste and want to work on it equitably, we will have to invite patients to the table from the outset.
Bring the public in early and often in medical technology assessment discussions.
Don’t say you are committed to “patient-centered care” if you don’t bring patients to the table. Warning: If you leave patients out, the public sees it as smacking of benefits denied, arbitrariness, and cheapness.
But the other thing is that until we stop rewarding doctors based on volume, and instead, inspire outcomes, we are going to drown in the morass of waste.
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