Installing an electronic health-record system doesn't by itself appear to improve quality of care for strokes, according to a large study published in the Journal of the American College of Cardiology.
“We thought we might see an effect, and we didn't,” said Dr. Karen Joynt of the Harvard School for Public Health, lead author of the study. The study examined more than 626,000 stroke patients cared for between 2007 and 2010, matching patients whose care occurred in hospitals with an EHR to patients whose care occurred in hospitals without one (but were still participating in a stroke quality-of-care program).
There was, she noted, a small benefit: Patients cared for in hospitals with EHRs had a slightly smaller likelihood of a prolonged stay at the hospital.
Joynt expected a more significant positive effect because stroke guidelines were changing substantially during the study period and software-driven reminders seemed likely to help physicians keep up with them.
The results add to the long-running debate over the benefits gained by adopting EHRs, which require substantial investment by physician practices and hospitals and have been heavily subsidized by the federal government under the American Recovery and Reinvestment Act.
The evidence is mixed, said Dr. John Windle of the Nebraska Medical Center, who wrote an accompanying editorial urging the government to back off penalties stemming from its EHR incentive program. “It's really premature,” he said.
In some circumstances, EHRs seem to benefit care, but simply installing the software is not enough, he said. The design of the incentive program, which penalizes all providers for failing to adopt and meaningfully use the technology, suggests that the positive results achieved by a few organizations can be generalized to the whole industry.
Joynt, meanwhile, said the results suggest the industry should pay more attention to EHR design and integrating the software into clinicians' work. “Their interfaces aren't terrific, and they don't have the ability to really link people together to care for complex patients,” she said.
Stroke patients are a perfect example.
“You need rehabilitation care, potentially occupational therapy, speech therapy, physical therapy, they need to get their medications correct," Joynt said. "They need all these things not just to survive the stroke, but have the lowest level of disability possible."
“Having a computer screen on which you can read other people's notes doesn't do that,” she concluded. “It's not that (the EHR) couldn't. It's just that it doesn't.”