Do Electronic Records Cut Health Costs? Re "Digital Records May Not Cut Health Costs, Study Cautions" (Business Day, March 6): Your article reminds us that while electronic medical records are a powerful tool, they are not a panacea for lowering health care costs. Electronic medical records can guide evidence-based care, prevent unnecessary duplicate testing, enable better and more informed care coordination for patients, and generate quality data in real time to help us measure the efficacy of rendered care to improve health outcomes. But if used only to facilitate the federal and state reimbursement models that pay for service volume rather than value to the patient and payer, electronic medical records can needlessly increase costs. Reducing long-term health care costs requires a fundamental redesign of how we pay for care to reward producing the best outcomes for patients in the most cost-effective way possible. Those of us who have long used electronic medical records appreciate their full potential to transform the delivery of care. We may not be able to prove cost savings, but we do know that they are instrumental for high quality. With federal and state payment reform, electronic medical records may just be able both to improve outcomes and reduce costs. ALAN D. AVILES President, New York City Health and Hospitals Corporation New York, March 6, 2012 The research cited in this article implies that digital health records contribute to greater health care costs by making it easier for physicians to approve and order expensive imaging tests. This is like implying that e-mail contributed to the economic crisis by making it easier for bankers to approve and process all those bad mortgages. The reality is that technology alone is not the answer to any of our big challenges, but neither is it the cause. This is especially true when it comes to reducing skyrocketing health care costs. The answer lies in using technology to empower consumers to make better lifestyle choices and to become active participants in their health. Digital health records will be a piece of this solution. FRANK MOSS Cambridge, Mass., March 6, 2012 The claim that electronic medical records may not cut health costs appears to be an exception to the rule. Embedding decision support tools as performance measures and clinical guidelines into the electronic medical record can improve the quality of care and reduce costs. At Weill Cornell, we are part of an imaging project by the Centers for Medicare and Medicaid Services that provides such tools, developed by the American College of Cardiology and the American College of Radiology, to educate physicians as to the right test for the right patient. An electronic medical record embedded with appropriate use criteria informs the referring or testing physician whether a test is appropriate, uncertain (more scientific studies are needed) or inappropriate. Patient preference and clinical data may overrule performing tests considered inappropriate. Commercial payers are also now providing valuable data on the frequency of use and costs of imaging tests, permitting physician quality improvement initiatives that ensure value-added, safe and satisfying care to patients. The writer, a cardiologist, is chairman of managed care at Weill Cornell Medical College and a past president of the American College of Cardiology.