Friday, October 19, 2012

Doctors Using Electronic Health Records Provide Higher Quality Healthcare

The use of electronic health records is linked to significantly higher quality care, according to a new study¹ by Lisa Kern and her team, from the Health Information Technology Evaluation Collaborative in the US. Their work appears online in the Journal of General Internal Medicine, published by Springer.

Electronic health records (EHRs) have become a priority in the US, with federal incentives for 'meaningful' use of EHRs. Meaningful use entails tracking and improving specific patient outcomes, as well as gathering and storing information.

Kern and colleagues examined the effect of EHRs on ambulatory care quality in a community-based setting, by comparing the performance of physicians using either EHRs or paper records. They assessed performance on nine specific quality measures for a total of 466 primary care physicians with 74,618 patients, from private practices in the Hudson Valley region of New York.

The quality measures included: eye exams, hemoglobin testing, cholesterol testing, renal function testing for patients with diabetes, colorectal cancer screening, chlamydia screening, breast cancer screening, testing for children with sore throat, and treatment for children with upper respiratory infections.

Approximately half of the physicians studied used EHRs, while the others used paper records. Overall, physicians using EHRs provided higher rates of needed care than physicians using paper, and for four measures in particular: hemoglobin testing in diabetes, breast cancer screening, chlamydia screening, and colorectal cancer screening.

The specific quality measures included in this study are highly relevant to national discussions. Of the seven quality measures expected to be affected by EHRs, all seven are included as clinical quality measures in the federal meaningful use program. There has been little evidence previously that using EHRs actually improves quality for these measures.

This study took place in a community with multiple payers. This is in contrast to integrated delivery systems, such as Kaiser Permanente, Geisinger, and the Veterans Administration, all of which have seen quality improvements with the implementation of health information technology. Most health care is delivered in “open” rather than integrated systems, thus increasing the potential generalizability of this study.

The authors conclude: "We found that EHR use is associated with higher quality ambulatory care in a multi-payer community with concerted efforts to support EHR implementation. In contrast to several recent national and statewide studies, which found no effect of EHR use, this study's finding is consistent with national efforts to promote meaningful use of EHRs."

1: Kern LM et al (2012). Electronic health records and ambulatory quality of care. Journal of General Internal Medicine; DOI 10.1007/s11606-012-2237-8

1 comment:

  1. A few parameters of the study should be taken into account when judging whether it represents the difference between EHRs and paper fairly.

    First, it defines quality as following recommended procedures. I believe that's an aspect of quality, but I'd like to see studies reporting how many patients have to return, how many get better, etc.

    Second, the study may suffer from the classic problem of failing to account for other differences between providers that might account for different outcomes. The report seems to focus on one geographic area, which eliminates one source of differences. The authors report that the physicians were normal in relation to other physicians across the country, and collected information on age, gender, degree, specialty, county, and practice size. but I don't think there's any information about their relative educational level or other things that might make a difference.

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