BLOGSCAN - Electronic Health Records and Clinical Decision Support Systems: Impact on National Ambulatory Care Quality

From the blog of Dr. Sanjay Gupta at CNN health:

Electronic health records no cure-all

Electronic medical records, also known as EHRs, often touted as a powerful antidote for uncoordinated and ineffective medical care, do little to help patients outside the hospital, according to a new study.

Researchers from Stanford University analyzed federal data on more than 255,000 patients, about a third of whom had health information carried electronically. The researchers compared the care of those patients to the care of patients without EHRs, on 20 different measures of quality – for example, whether proper medication was prescribed for patients with asthma or simple infections, or whether smokers were counseled on ways to quit. On 19 of the 20 measures, there was no benefit from having an EHR. The one exception was dietary advice: Patients at high-risk for illness were slightly more likely to receive counseling on a proper diet.

The U.S. Department of Health and Human Services has pushed hard to encourage the adoption of electronic medical records, including $19 billion worth of incentives for doctors and hospitals. A move to EHRs is one of the less controversial aspects of health care reform, and the shift is often touted by President Obama.

But skeptics say there are serious risks to an overreliance on EHRs, from missing information to simple computer crashes. A report last month from the ECRI Institute, a respected organization that studies science and health issues, listed “data loss and system incompatibilities” as one of ten “Top 10 Health Technology Hazards for 2011.”

Jeffrey C. Lerner, president and chief executive officer of the ECRI Institute, said the new findings are no surprise. "It is reasonable to assume that electronic health records will ultimately help the cause," he told CNN in an email, "but new technology has a learning curve. [Somehow, this "new technology" that dates back decades is having one hell of a long learning curve - ed.] Think of your smart phone. Improving quality will remain a tough challenge, but avoiding technology use doesn’t sound like an alternative.”

To examine whether better technology might help, the Stanford team also looked at whether care was better when physicians used a computer system to help guide them through treatment options. It barely made a difference.

The project was started by Max Romano, an undergraduate at the time who now studies medicine at Johns Hopkins University. The final paper was co-written with Dr. Randall Stafford, a professor at the Stanford Prevention Research Center.

"Our initial hope was that we would see a correlation between electronic health records and quality, and when we looked at the subset of patients whose doctors got help from the clinical decision support systems [decision-making software], we'd see an even stronger relationship," says Stafford. "Perhaps we need to re-examine the naive assumption that just putting in place an EHR system will make a huge difference." [That's called "technological determinism" - ed.]

While praising federal efforts to standardize and streamline EHRs, Stafford said the findings raise serious questions about the scope and speed of the $19 billion campaign. "There is a need to question investing that much societal resource in electronic health records when we really don’t know the answer of what effects those are going to have. Having made that decision, it's incumbent for us to demand exactly what we have gotten out of the investment."

Post by: Caleb Hellerman - CNN Medical Senior Producer

Once again, as I pointed out here, you've seen these questions raised long ago at Healthcare Renewal and at a much older site on health IT difficulties the authors may not be aware of, specifically here.

The CNN post describes results reported online in the Archives of Internal Medicine:

Electronic Health Records and Clinical Decision Support Systems: Impact on National Ambulatory Care Quality
Max J. Romano, BA; Randall S. Stafford, MD, PhD
Arch Intern Med. Published online January 24, 2011. doi:10.1001/archinternmed.2010.527

More on the primary article later.

I'm busy helping managing the medical care of my relative's 2010 EHR-related injuries.

-- SS

Addendum:

My followup post on the primary article is here.