Do EHRs Improve Clinical Outcomes? An Objective View

Objectivity is a difficult skill to master, whether you're a health IT vendor, a clinical end user, or even a government agency responsible for evaluating technology. And while absolute objectivity isn't possible, it seems some stakeholders aren't trying hard enough.

The Office of National Coordinator (ONC), for instance, has gone out of its way to defend the value of IT tools in patient care, even in the face of contrary evidence. For example, when Stanford University investigators looked at data from more than 250,000 ambulatory patient visits, they found "no consistent associations" between electronic health records (EHRs), clinical decision support systems, and better quality, according to a report in the January 24 issue of Archives of Internal Medicine. ONC challenged that finding because it was based on an analysis of 2005 to 2007 data, which meant the clinicians were using older IT programs.

But now comes evidence that EHRs do indeed improve clinical outcomes. A study published in the Sept. 1 issue of the New England Journal of Medicine may be the solid proof that EHR advocates have been waiting for. The research shows a large difference in outcomes among diabetics whose healthcare providers use EHRs compared with those who still use paper records.

Researchers from three major healthcare organizations in Cleveland--MetroHealth System, Cleveland Clinic, and Ohio Permanente Medical Group, an affiliate of Kaiser Permanente--found significantly greater adherence to standards of care and better outcomes for diabetes patients cared for with EHRs.

The investigators examined data on more than 27,000 adults with diabetes at 46 practices in northeastern Ohio and performed an analysis based on nine metrics. Those metrics measured the standards of care used to treat diabetes and measures used to determine what effect treatment had on clinical outcomes. They found that 50.9% of patients at sites with EHRs received care that met four important care standards, but only 6.6% of patients at practices using paper-based processes did.

In practical terms, that meant patients cared for through the use of EHRs were far more likely to have their glycated hemoglobin (an indicator of their blood glucose level over several months) measured, have their kidney function monitored, have an eye exam, and receive pneuomococcal vaccination.

In terms of outcomes, 43.7% of practices with EHRs met several standards, compared with 15.7% of those whose doctors didn't have EHRs. Patients hooked into e-records achieved lower glycated hemoglobin, blood pressure, and LDL cholesterol levels, and they were less likely to smoke.

It's hard to ignore such strong data from tens of thousands of patients. The task at hand is for IT execs and clinicians to take a closer look at this study to figure out how they can apply it to their own facilities--if at all. It's the only objective course to take.

Find out how health IT leaders are dealing with the industry's pain points, from allowing unfettered patient data access to sharing electronic records. Also in the new, all-digital issue of InformationWeek Healthcare: There needs to be better e-communication between technologists and clinicians. Download the issue now. (Free registration required.)