EHR Use Alone Doesn't Improve Care, Say Studies

Two recently released studies assessing the relationship between the use of electronic health records, or EHRs (also referred to as electronic medical records, or EMRs), and the quality of health care delivered to patients came to similar conclusions: The mere use of an EHR in an ambulatory care setting did not improve the quality of health care delivered to patients.

"Electronic Health Record Use and the Quality of Ambulatory Care in the United States," published in the July 9 Archives of Internal Medicine, examined the association of EHR use, as implemented in the practices assessed, with 17 ambulatory quality indicators via a retrospective cross-sectional analysis of visits cited in the 2003 and 2004 National Ambulatory Medical Care Survey.

EHRs were used in 18 percent of an estimated 1.8 billion ambulatory visits made in the United States in 2003 and 2004. Survey results showed that for 14 of the 17 quality indicators measured for these visits, there was no significant difference in performance on quality indicators between practices that used an EHR compared with practices that did not use an EHR.

Performance on quality indicators was defined as the percentage of applicable visits in which patients received recommended care; quality indicator categories included medical management of common diseases, recommended antibiotic prescribing, preventive counseling and screening.

"As implemented, EHRs were not associated with better quality ambulatory care," wrote the authors in the study's abstract.

"Electronic Medical Records and Diabetes Quality of Care: Results From a Sample of Family Medicine Practices," published in the May/June issue of Annals of Family Medicine, focused on quality-of-care data on patients with diabetes from 50 family medicine practices. Of those practices, 13 used an EMR; 37 did not. The data were collected between April 2003 and December 2004.

The study authors concluded that the use of an EMR in primary care practices was insufficient to ensure that high-quality diabetes care was provided. "Efforts to expand EMR use should focus not only on improving technology but also on developing methods for implementing and integrating this technology into practice," said the study authors.

According to an overview of the Annals article, variations in EMR system features, the degree to which clinicians used the EMR, and the availability of resources to support such efforts all likely contributed to the outcomes observed.

Steven Waldren, M.D., director of AAFP's Center for Health Information Technology, or CHiT, agreed with that assessment, saying important information was missing from each of the studies -- namely, details about the functionality of the EHRs involved and how the physicians were using those EHRs.

In particular, the studies didn't stratify the EHR product groups, and that's an important distinction because EHR products in the marketplace range in price from about $3,000 to $134,000 and more depending on the features offered, said Waldren, citing CHiT's 2005 Partners for Patients EHR vendor survey. (10-page PDF file; About PDFs.)

"The systems with integrated disease registries, system support and outcomes measures -- those features and functions that drive quality and safety -- are more likely to be in the higher price range," he said. On the other hand, an EHR that just helps a physician with documentation and efficiency is probably going to cost less.

Waldren said that physicians want EHRs that can help them document patient care and increase office efficiencies because, from a financial standpoint, those are the features they need to keep their practices viable in today's market. "There's currently no appreciable financial incentive for physicians to purchase high-end EHRs that help drive quality and safety," said Waldren.

Indeed, recently released results from the AAFP's EHR member survey showed that 99 percent of physicians who were in the process of implementing or who planned to purchase an EHR were interested in efficiency and documentation features, such as managing patient medication lists, problem lists and patient summaries.