by Robert Bazell
Chief science and health correspondent
NBC News

When it comes to the multiple challenges of health care reform, ideas that look good on paper often do not turn out as planned in the real world. Two excellent examples appear in the latest issue of the prestigious journal Health Affairs.

The first concerns electronic medical records. Most health reform proposals, including the law passed by Congress and signed by President Barack Obama, include strong incentives for computerizing health records. One of the major arguments favoring electronic records is cost savings. Doctors, the argument goes, will see all the tests a patient has undergone and not order duplicates, a well-established cost escalator. 

Studies in high-end hospitals and computing groups did find savings. But the latest research looked at 28,741 patient visits to 1187 community physicians.  The authors found that the doctors who had access to electronic records were 40 percent to 70 percent MORE likely to order an image such as an X-ray or MRI or a blood test.  One reason, the researchers speculate, is that the electronics just makes ordering tests easier by eliminating the paper work.  And they conclude “the federal government’s ongoing, multi-billion efforts to promote the adoption of health information technology may not yield the anticipated cost savings from reductions in duplicative diagnostic testing.” 

Since 2005 the federal government has been publishing safety ratings data from most hospitals in a system called Hospital Compare, with the hope the information would increase accountability and steer patients to better quality facilities.  But the reporting system has led to no reduction in complications beyond existing national trends for heart attack and pneumonia and only a slight reduction in mortality for heart failure, the researchers found after examining Medicare claims forms. The authors conclude that the government’s reporting system “did not result in patients’ shifting toward high quality hospitals.”  When it comes to health care -- despite the wishes of reformers -- patients are not consumers who shop for quality but tend to be far more passive, checking into the hospital that is either convenient or recommended by their doctor.

Both reports touch on small parts in the many challenges of health care reform, but show how tough the process is.

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