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2/7/2011
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Blumenthal Slams EHR Critics

The national coordinator for health IT said a recent study that showed little clinical benefits from electronic health records is flawed.

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Dr. David Blumenthal, national coordinator for health IT, took a swipe at a recent study published last month in the Archives of Internal Medicine that showed that the use of electronic health records (EHRs) did not significantly improve the quality of patient care, even when they were used with clinical decision support (CDS) systems that help health professionals make clinical decisions to better manage care for patients.

During a question and answer session with reporters at last week's Direct Project health information exchange launch, Blumenthal said that the database used and the timeframe in which the study was conducted were contributors to flawed results. He also said EHR technology has improved since the study was done.

"I don't consider that database a very sensitive one for the kind of results that we are looking for," said Blumenthal, who announced Thursday that he will be resigning his post this spring. "I also would point out that it was done with data from 2005 to 2007, not with electronic health records in their modern form and not under the influence of the meaningful use requirements which require a higher level of performance than was true of the electronic health records that were discussed," he added.

The study, conducted by Dr. Randall S. Stafford, associate professor of medicine at the Stanford Prevention Research Center in California, and Max Romano, an undergraduate at Stanford during the time of the research, analyzed nationwide survey data from more than 250,000 patient visits to physicians' offices and other outpatient settings between 2005 and 2007.

The study reported, "The use of EHRs was not consistently associated with higher-quality care. Among all outpatient visits, those at which an EHR was present showed significantly better performance in only 1 of 20 quality indicators based on unadjusted data (diet counseling in high-risk adults). In the other 19 indicators, there was no statistically significant difference in quality based on the presence or absence of an EHR."

It also said, "Clinical decision support also was not associated with higher-quality care. Among EHR visits, CDS was associated with better performance on only 1 of 20 ambulatory care quality indicators: avoidance of unnecessary electrocardiography during routine examinations. In the other 19 indicators, there were no significant differences in quality."

Stafford told InformationWeek that the research was based on the most recent federal survey that contained complete information on EHR use and quality, and noted that while the timeframe for the study predates Blumenthal's role with the Obama administration, there was no evidence suggesting improvements over time as EHR use became more prevalent.

"I have no doubt that changes are beginning to occur and that more recent data may begin to show some gradual progress. Unfortunately, past history suggests that these changes will be slow in coming," Stafford said.

In the meantime, while addressing a reporter's skepticism regarding the merits of spending billions of dollars to implement EHRs while the Stanford University study showed the technology may not improve the quality of patient care, Blumenthal took the opportunity to expand on the virtues of EHR adoption, telling journalists that the administration's efforts to accelerate the adoption of EHRs is validated by many other peer-reviewed studies that showed EHRs led to cost reductions and quality improvements in patient care.

"There are plenty of strong studies that justify what we are doing [and] there are plenty of physicians who are using electronic health records who will never go back to paper," Blumenthal said. "I have used an electronic health record, I saw the value in my own practice, and beyond that the idea that in 21st century America we will withhold from patients the benefit of electronic systems when the rest of the world is zooming ahead with ever more powerful uses of information for the rest of their lives strikes me as inconceivable and also irresponsible," Blumenthal added.

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