It’s unclear whether electronic health records will reduce healthcare costs or improve care, according to a new paper in the journal Health Affairs.

The author argues that a literature review of studies on EHRs show that the technology can lead to increased billing, make doctors less productive and does not change provider-to-patient ratios.

“Absent other fundamental interventions that alter medical practice, it is unlikely that the U.S. health care bill will decline as a result of the EHR alone,” writes Jaan Sidorov, MD, an associate in the department of general internal medicine at Geisinger Medical Center, in Danville, Pa.

The paper, published in the July/August issue of Health Affairs, examined EHRs in ambulatory care. However, the study’s author says the research could also apply to hospitals and other inpatient settings. Sidorov said the paper was not intended to examine all of the arguments in favor of EHRs.

The author argues that installation and maintenance expenses or EHRs will be passed to the consumer through increased billings. Without improvements in care quality or efficiency, “costs are likely to be accelerated,” he writes. He also writes that the literature on potential medical error reduction is unclear.

A study by the Rand Corp. found that national adoption of the EHRs could result in more than $81 billion in annual savings.

In an interview with Healthcare IT News, Sidorov said that although EHRs can be useful in facilitating pay-for-performance programs and management of chronically ill patients, it’s just one tool to provide better care.

“The EHR is necessary to make that happen, but not sufficient,” said Sidorov, who practices in a paperless environment.

Some in the healthcare IT community agreed that technology alone is not the answer.

“EMRs are not a silver bullet. They are a tool,” said Carla Smith, executive vice president of the Healthcare Information and Management Systems Society.

Michael Davis, executive vice president of HIMSS Analytics, the research arm of HIMSS, said that most EHR users have not installed some of the advanced functions that are expected to bring improvements in care and reduced costs.

“People simply haven’t implemented enough of the EMR to realize the impact,” he said.

David Merritt, a project director with the Center for Health Transformation in Washington, D.C, said that while EHR implementations can cause short-term declines in physician productivity, the long-term benefits outweigh near-term setbacks.

“There are a lot of difficulties [with EHRs] to overcome,” Merritt said. “Overtime, those will be minimized by the benefits that everyone will see.”