Steven P. Cohen, MD, an associate professor of anesthesiology and critical care medicine at the Johns Hopkins University School of Medicine, has studied the overuse of medical imaging in spine care, which he says often adds little value but adds significant costs. He says it's critical that increased patient access to medical records does not lead to more inappropriate imaging.
"The use of imaging does not seem to affect decision-making or improve outcomes in the large majority of individuals," he says. "So while I think that patients have a right to know the results of tests done on them, I don't think they should be the ones who decide on whether they are indicated—unless they are paying for them."
Ted Eytan, MD, MS, MPH, a director for the Permanente Federation at Kaiser Permanente, says facilitating patient access to their medical imaging will help to educate the patient and demystify the technology. "What will happen now is they will start to understand the limits of imaging," he says.
"Sometimes these imaging reports come back and do not reduce the uncertainty that the patient has, and the patient thinks, 'Why did I spend two hours in a box if this was not a justifiable expense that didn't change the condition?'" Eytan says. "Especially if they are going to pay for this, they are going to ask questions: 'Why are we doing this?'"
Walker agrees that cost-shifting will make for more discriminating patients. "The incentives are going to be different, so it seems like a well-informed patient could spend money more wisely as patients are spending more out of pocket," Walker says.
"And it certainly seems logical to have patient eyes on what is going on with care so that they could head off some errors early if a patient spots something wrong. It would provide opportunities for patients to say, 'I don't need a test. I already had it, and here are the test results right here,'" she says.