Quality doesn't go hand-in-hand with use of EHRs



Using electronic health records (EHRs) may not necessarily improve patient care in doctors' offices, according to a study in the Archives of Internal Medicine (7/9/2007). Researchers examined EHR use throughout the United States, using data from the 2003 and 2004 National Ambulatory Medical Care Survey to determine the association between this health information technology and 17 ambulatory quality indicators.

The researchers found that EHRs were used in 18% of the estimated 1.8 billion patient visits in 2003 and 2004. For 14 of the quality indicators, the researchers found "no consistent association between EHR use and the quality of ambulatory care." However, for two quality indicators (not prescribing benzodiazepine patients with depression and avoiding urinalysis testing during general medical exams), an improvement in patient care was seen when EHRs were used. And in the case of one quality indicator-prescribing a statin to patients with hyperlipidemia-this quality indicator actually saw a decrease in the quality of care with EHR use, although researchers say this could be a statistical glitch,

So, why haven't EHRs improved patient care in office settings? Researchers suggest that health information systems used in ambulatory care settings may not include clinical decision support nor focus on improvement. Moreover, physicians' offices that do have complete systems (which include electronic prescribing, test ordering, results, and physician clinical notes) may not be using the clinical support decision tools.

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raanan meyer, md
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