I will grant you that the evidence supporting quality of care and the electronic health record has vacillated over the years. Rigorous case-controlled studies have not been conducted, as you have pointed out. Nonetheless, there is mounting evidence that EHRs improve the quality of care and the efficiency of delivery of healthcare. Samuel Wang has shown that there is a cost benefit to the EHR. There have been studies that have demonstrated a worsening of outcomes with IT intervention. However, on balance, the benefits have outpaced the bad results.
If you do not measure something, how do you know if you are making things better? This is true in caring for patients, as well as implementing the EHR. Benefits have shown reduced adverse drug events and improvement in compliance with preventive care. Also, if the EHR improves the ability to track surrogate markers, which have been proven to be of benefit in the medical literature, the inference is that this will improve care. For example, surrogate markers include blood pressure control, lipid management, influenza immunizations, congestive heart failure control through the use of telemedicine techniques and other Healthcare Effectiveness Data and Information Set measures.
As usual, there is a right and a wrong way to implement the EHR. Far too often, it has not been done properly. Also, you have to implement across many areas, and integrate these areas. Due to perverse incentives, the physician bears the cost of implementing, but the benefit goes to other parties such as the insurance company or the pharmacist. Only in integrated delivery systems can you make a compelling argument that the EHR is highly cost-effective for the physician. Only recently has the CMS started to consider pay-for-performance; however, it will take many more external forces to help implement the EHR. The national health information network will help, since physicians will have something to plug into and get immediate benefit once it is completed.
Kevin Rosteing, M.D.Student of medical informaticsMilwaukee School of EngineeringGreen Bay, Wis. To submit a letter to YOUR VIEWS, click here. Please include your name, title and hometown.