Electronic Health Records: Going Digital May Not Improve U.S. Patient Care

Electronic health records -- touted by the White House as a key way to improve healthcare in the United States -- may actually do little to improve quality, U.S. researchers said on Monday.

A team from Stanford University in California analyzed nationwide survey data from more than 250,000 visits to physicians' offices and other outpatient settings between 2005 and 2007.

They found electronic health records did little to improve quality, even when there was "decision support" software that gives doctors tips on how best to treat individual patients.

"Across a wide range of quality indicators there was no consistent association between having those electronic tools available and providing better quality of care," said Dr. Randall Stafford of Stanford, whose study appears in the Archives of Internal Medicine.

Electronic health records systems that include this software have been shown in other studies to significantly improve health quality.

President Barack Obama has made using information technology a central plank in his plan to cut costs out of the U.S. healthcare system, offering up to $27 billion in government funds aimed at speeding the switch to electronic medical records.

The push is largely based on the assumption that moving to electronic from paper records will improve communication and reduce medical errors. But that may not be so.

'MORE REALISTIC'

In a prior study, Stafford's team showed that simply putting paper records into a digital format did little to improve care. In the new study, the team looked at whether adding decision support tools helped.

The tools remind doctors of guidelines for treating specific conditions. For example, they might remind a doctor to order a specific test, or a specific antibiotic.

But the software tools did not significantly improve quality of care, Stafford said. He said the study suggests that improving health quality will take more than just adding information technology to the mix.

"We need to be more realistic about what to expect from electronic health records," Stafford said in a telephone interview.

"I believe this study suggests that it is naive to believe that the simple presence of an electronic health record or even these systems with more advanced functionality will by themselves change the quality of care," he said.

In a commentary in the same journal, Drs. Clement McDonald and Swapna Abhyankar of the National Institutes of Health said Stafford's findings were "dismal."

They said other studies have found well-implemented decision support programs have been shown to improve care, and it may be that the systems in the study were immature, and better training would improve the outcome.

Stafford said stimulus funding to standardize medical records may improve what he said is now a patchwork of systems.

Health information technology companies include Cerner Corp, McKesson Corp and Quality Systems Inc, as well as larger technology companies such as General Electric's GE Healthcare unit, Siemens, Microsoft Corp and Google Inc.

Copyright 2010 Thomson Reuters. Click for Restrictions.

Comments

[eialbur]

07:40 PM on 01/27/2011

The 'exchange' standards they are using (e.g. C32) are HORRIBLE and USELESS. I have written code for medical data exchange, and until they come up with better standards we are simply throwing money down the drain.

[onionboy]

01:14 PM on 01/27/2011

No kidding. Has email given you more free time? Has MS Office decreased your workload at the office?

[WriterGirl]

01:14 PM on 01/27/2011

Automating an exceedingly complex, cumbersome, and poorly designed hodgepodge of business processes just makes the exceedingly complex, cumbersome, and poorly designed hodgepodge of business processes run faster. And bill faster. And if you haven't reviewed an EMR system lately, I'll just go ahead and let the cat out of the bag: the latter point (billing) is the primary consideration of the systems.

[skyblu]

08:48 AM on 01/26/2011

$10 billion over five years approved by Dept of Health and Human Services Sebelius appropriated for heatlh IT while tens of millions of Americans don't have access to healthcare!

Priorities and judgement are so twisted and lacking by pols and Administrators,
God help the American people.

Where is the hue and cry over this grotesque waste and abuse of U.S. tax dollars and
criminal neglect of public health and welfare?

Get rid of Federal IT contacts, period. Side effect? Ability to carry out the Constitutional responsibility of the Federal Government to the people of this country and the State!

[Telly Savalas]

10:25 PM on 01/26/2011

You are misinformed. It is $19.2 billion.
And you have no idea about the the money and its intended use.
Educate yourself or shut up.
The title of the program is "Meaningful Use - Improvement in Patient Care".
The final rule runs 267 pages - available on the web. Whe you have read it and understand the intent and letter of the law, then you can talk about it.
Ignoramus!

[huffdog]

02:10 PM on 01/27/2011

nice.

[Diasamax]

08:34 PM on 01/25/2011

Correction: EMR = Electronic Medical Record, same thing as EHR the Electronic Health Record

[Diasamax]

08:33 PM on 01/25/2011

Although there are doctors that do not want to use EMR, the bottom line is simple. Many people died after Hurricane Katrina because no medical records existed. That is why Bush mandated the EMR be put into place. If they were on a database that could be accessed, many would not have lost their lives. An EMR has to be accessed in the office and off site. If with a company that specializes in medical record management, they too would have a back up system off site, to help insure access to those records. If there is a major emergency with you or a family member, are doctors really expecting us to believe they know all the medical details of every single patient in their practice? When they are called by another facility during off hours, they are not walking around with the files of all their patients in their hands.

The information recorded has too be accurate regardless of the format. However, if this process helps make sure that someone in a major emergency does not have an adverse reaction to a medication or even the latex usually used in the hospitals (which are not only the gloves, but the covers for needles and the tubing for IV's are made of them as well) then it is worth the effort.

[skyblu]

08:55 AM on 01/26/2011

Many people died because the Federal Government failed to oversee and audit the work of the Army Corps of Engineers to ensure the levees every time were built to spec with proper material.

Point 2: Hitler's ability to identify and exterminate those he hated and wished to have access to their properties and wealth was only possible with the help of IBM... computerization of demographic data.

Point 3: Had Dubya not appointed a HACK Arabian horse dude to head up the Federal Emergency Management Office of the USA, fewer would have died to begin with. Had Dubya not invaded Iraq , the U.S. Army Reserve in force would have been available to immediately rescued tens of thousands of New Orleans people.

Point 4: No IT system is secure; none! Why would anyone want their most important personal information, i.e., healthcare records, to be established in electronic form given the obvious potential, real potential, for devious and destructive uses.

You live in a fool's paradise. Experience leads to a vastly different conclusion on this issue.
Critical thinking, looking before leaping would have immediately proven the benefits are miniscule as compared to the costs of health record IT.

[Telly Savalas]

10:27 PM on 01/26/2011

You, sir or madam, are a twit.

[oldlady2000]

05:06 PM on 01/25/2011

There are so many problems with this study I don't know where to begin. EHR technology in 2005 - 2007 is nowhere close to what it is today. Also, it's survey data; that is pretty suspect. Note: "Across a wide range of quality indicators there was no consistent association between having those electronic tools available and providing better quality of care," Of course, not! Just having it available is like having a Mercedes sitting in your garage then saying it does not improve your driving performance. I work in this field and know there are Doctors who don't really use the important features and others who use them to the fullest. What do think the results are? Those who really use the EHR find great benefit and those who just have it installed but don't use it much don't find it useful. Also, you really need to discriminate between those EHRs which are cheap low-level and those which perform at high levels. Study after study shows e-prescribing alone vastly improves the medication error rate. You don't have to be a MD to evaluate good science from bad science.

[John Nail]

02:06 PM on 01/25/2011

The value of EHR's is less in the record itself and more in the ability to have the data and constituents in healthcare be connected electronically from appointments, thru referrals, reduced tests, e presecribing, simplified billing, faster payment et al. The NHIN is the backbone for a Healthcare Info Highway - akin to the interstate system built in the 1950's and 1960's. Being able to connect all the players instead of have them all in silos will save up to 50% of cost before care is improved.

[Dan1902]

01:21 PM on 01/25/2011

Regardless of how it effects care it WILL save money and that is the ultimate problem with Healthcare----The Cost!

[hitchanvil]

03:09 PM on 01/26/2011

"Medicare official tells the House Budget Committee that President Obama's health care law won't hold down costs and that it won't let everyone keep their current health insurance — even if they like it."

Subtitle from several news reports just released today. BHO is the chief liar & thief in charge.

[Dan1902]

03:20 PM on 01/26/2011

Electronic medical records will save money patsy!

[pspmd]

01:13 PM on 01/25/2011

we doctors have known this from the beginning...hopefully dr. obama is learning...

[Chas53]

08:44 PM on 01/25/2011

Yep

[alongst]

07:50 PM on 01/26/2011

EHR's do nothing to help us, since most of the time I cannot access the patients record due to idiotic government HIPAA laws. Example- I was called to a code on the floor and intubated a patient. I then went to look at the post intubation xray- and was denied access to it because I wasn't the patient's doctor ! At 3 AM no less.
The only reason the government wants EHR's is that it is much easier to audit them instead of having to physically look at them.
It's all about the government.

[Telly Savalas]

10:35 PM on 01/26/2011

HIPPA is not the problem. Your institution interprets the rules as it sees fit and many are clueless. Don't blame the government for the flawed "healthcare system" which is owned entirely by the big insurance/pharma corps.