A published report indicating that the use of electronic health records may not necessarily lead to an increase in the quality of care has caught both healthcare providers and vendors off-guard.
No quality boost?
Study reveals ‘surprising’ EHR data
The report, Electronic Health Record Use and the Quality of Ambulatory Care in the United States, concluded: As implemented, EHRs were not associated with better quality ambulatory care. The report appeared in the July 9 edition of the Archives of Internal Medicine.
The result was surprising, said the studys lead author, Jeffrey Linder, an assistant professor of medicine at Harvard Medical School and an internist at 746-bed Brigham and Womens Hospital, Boston. I was expecting to find that it (EHR use) was associated with better care.
The study examined records of 50,574 patient visits collected as part of the National Ambulatory Medical Care Survey in 2003 and 2004, and compared how physicians with and without EHRs did on 17 quality measures. The researchers concluded that EHR-using physicians had significantly better scores on only two quality indicators, had no significant difference on 14, and did significantly worse on one.
The two measures that the EHR-using physicians scored significantly better involved avoiding prescribing benzodiazepine to patients with depression and avoiding unwarranted urinalysis testing. The authors were surprised to report that EHRs were associated with worse quality when it came to prescribing statins to treat high cholesterol.
Linder said that he spent two days in vain trying to figure out that result. It could be just statistical chance ... it could be a statistical anomaly, he said. I dont have a good explanation.
Linder said that most EHR quality studies have been done at what he described as benchmark institutions, and the intent of this studywhich was sponsored by the Agency for Healthcare Research and Qualitywas to take a more general view of how EHRs were being used across the nation.
What the study shows, Linder said, is that with the way EHRs are being used they are not much more than a replacement for the paper chart.
Theyre not magic, Linder said. You just cant plug it in, turn it on and watch quality magically improve.
EHR vendors, meanwhile, downplayed the studys outcomes. Its caused quite a bit of discussion in our industryto say the least, said Hugh Zettel, director of government and industry relations for GE Healthcare. We dont believe the reporting on it has been accurate relative to the findings of that paper.
Zettel disputed some of the findings, saying that GE Healthcares own research found that its customers had scores twice as high as those the researchers found on quality indicators relating to aspirin, beta blocker and statin prescribing. Mostly, however, he said that the findings may be a reflection of when half the data were collected: 2003. A lot has changed since then, he said, and this includes an evolving definition of EHR.
In addition to not offering a ringing endorsement of EHRs, the report also commented on the low level of quality in healthcare in general, and stated that it is worth noting that the performance on most indicators was suboptimal regardless of whether an EHR was used.
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