Study Examines e-Records' Utility

Another volley has been fired in the ongoing debate over the efficacy of electronic health records to improve patient care. It's not one EHR advocates will like.

Compared to a control group without e-records, hospitals and medical practices with EHRs improved in only one of 20 measures of quality (diet counseling for high-risk adults), say researchers at Stanford University. Among providers using EHRs with clinical decision support (CDS) tools, patient care also improved significantly in only one area: ordering electrocardiographs for low-risk patients.

"Our findings indicate no consistent association between EHRs and [clinical decision support] and better quality," the researchers conclude in the study, published online Monday by the Archives of Internal Medicine. "These results raise concerns about the ability of health information technology to fundamentally alter outpatient care quality."

The findings emerged from an analysis of physician survey data collected from 2005 through 2007 by the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey. The study, "Electronic Health Records and Clinical Decision Support Systems: Impact on National Ambulatory Care Quality," was conducted by Dr. Randall Stafford and Max Romano. They examined data on more than 255,000 patient visits over the three-year period.

The researchers concluded that their work raises doubts that clinical decision support tools unilaterally improve outpatient care: "In the absence of broad evidence supporting existing CDS systems, planned investment should be monitored carefully and its impact and cost evaluated rigorously."

The government, they suggest, has a role in ensuring that EHRs deliver on the promise of improving patient care:

In the absence of governmental impetus and standards, current adoption patterns may have fostered incomplete implementation and use of less effective technologies. Systematic federal intervention through [Health Information Technology for Economic and Clinical Health Act] may be needed to realize the potential of these technological advances.