Read all over: What causes a story to gain traction? Money talks.

By Mike Miliard
02:28 PM
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When one is a writer for a trade publication, one's e-mail inbox is peppered almost daily with press releases touting this or that study, significant for these or those findings, about this or that corner of the industry.

Usually, these surveys and white papers are of little interest beyond those who work in that particular field.

But every so often, a poll or a research study gets noticed. The mainstream media picks up on the story, and its implications are reported and dissected and commented upon, far and wide.

Such was the case this past month, when the journal Health Affairs came out with a study – with the rather ungainly title of "Giving Office-Based Physicians Electronic Access To Patients’ Prior Imaging And Lab Results Did Not Deter Ordering Of Tests" – whose authors found that "physicians’ access to computerized imaging results (sometimes, but not necessarily, through an electronic health record) was associated with a 40–70 percent greater likelihood of an imaging test being ordered."

Their conclusion, they wrote, was 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 wrote. "Indeed," they added, "it is possible that computerization will drive costs in this area up, not down.”

Before long, the research was being reported across the news media, from Indianapolis to Islamabad. "Digital Records May Not Cut Health Costs, Study Cautions," blared the headline in the New York Times – on whose website the story was trending, for a time, as one of the five most popular.

Other headlines echoed the sentiment: “Could Electronic Medical Records Add Costs?” (CNN); “New Study Challenges Whether Electronic Records Cut Health Costs” (News Hour); "Doctors order more X-rays, not fewer, with computer access" (Washington Post).


National Coordinator for Health IT Farzad Mostashari, MD, took strong issue with the study being framed in this way. "While such interpretations may make for attention-getting media headlines, it’s important to get the facts," he wrote in a blog post on the ONC site.

The upshot of the study, he argued, was simply that "doctors who order a lot of imaging tests are more likely to have electronic systems that let them view those images in their offices" – something he said was "not a particularly surprising observation."

Later, Mostashari even waded into the comments section on NYTimes.com, writing "[d]espite the headlines, the study tells us little about the ability of electronic health records (EHRs) to reduce costs. And it tells us nothing about the impact of EHRs on improving care."

A few days later, the authors of the study responded to the criticisms. "Some take us to task for claims we never made, or for studying only some of the myriad issues relevant to medical computing,” they wrote. “And many reflect wishful thinking regarding health IT; an acceptance of deeply flawed evidence of its benefit, and skepticism about solid data that leads to unwelcome conclusions.”

Leaving aside the merits (or lack thereof) of both sides' arguments – whether the study was too narrowly focused, or cherry picked facts, or relied on too-old data from 2008 – it's interesting to ponder how and why the story spread beyond the usual industry news sources and sparked the interest of the public at large.

Because as medical technology grows and evolves – and its impact on care continues to be more widely felt as health reform moves forward – it's imperative that the general public – the people who don't live and breathe health IT every day – get the right facts.

"One of the great mysteries is why certain stories get traction in the news and others don't," said film director Errol Morris in a recent interview with Esquire.

Certain factors can help tip the scales. Chief among them, says Morris, are "salacious details." Now, sure, this story has none of the sex or violence or seedy details that move stacks of tabloid newspapers. But it does have one something almost as journalistically titillating: money.

It seems doubtful whether a story about CDS-enabled EHRs saving someone's life by detecting a drug-allergy interaction gaining similar-sized traction. Or one highlighting the clinical benefits of the care coordination enabled by health information exchange.

But because this story purported to show not only that EHRs don't deliver the systemwide savings they promise but even "add costs," it seemed some people were all too happy to leap up and scream "I told you so!"

"Any time you publish anything that runs counter to the current wisdom, I think it gets a lot of press," reasons Erica Drazen, managing director, Global Institute for Emerging Healthcare Technologies at CSC. "Especially when it's about costs and EHRs." Also, "this was published right when the Stage 2 rule came out, so people were thinking about it."

That said, "if there actually were a good study that showed the use of EHRs dramatically increased costs, that would be newsworthy," she adds. "Unfortunately, this study didn't show that. The headline was totally deceptive. It says giving physicians the access to view images increases test ordering … that doctors who order a lot of imaging tests want to have access to view the results. That's it."


But that's not the conclusion most newspaper readers would draw, just from scanning the top of the story. "The fact that people didn't read the article and reported on it, and reached conclusions about EHRs is [a] problem," says Drazen.

Of all the stories about health IT to catch fire in the mainstream media, this one, with all the controversy around its methodologies and implications, seemed an especially weird specimen.

Especially now that health IT is becoming more visible to more people, and could be at a tipping point when it comes to the general public's knowledge and appreciation.

"The media, before they print a story they should at least read the information," says Drazen – who notes that this is not the first time she's had to respond to stories like this.

"This happens a lot, with research being mistitled and misrepresented," she says. "Maybe twice a year, something gets picked up and published and misinterpreted.

She says she sees it as her duty to "get the [correct] message out to my people in the field, so if some executive in a hospital comes up and says, 'Wait a minute!' then we can at least tell them what the story is."

After all, she says, especially nowadays, "it's just so important that we not get misinformation out."