I expect widespread use of computerized health records -- and most importantly the secure exchange of patient data for continuity and coordination of patient care -- is where some of the biggest boosts to quality and potential cost savings will come. That's making sure that patients discharged from hospitals not only have their records immediately available to their primary care doctors, but also to rehab facilities, home health care, or other caregivers, who are often stuck making treatment decisions based on phone-tag messages or patients' foggy memories of the drugs they've received, tests they've had, results and so on, as they wait for copies of sometimes illegible paper charts.
So far, the impact of EHRs on coordination of care has been difficult, if not impossible, to study unless researchers are mainly examining the few large and more-or-less managed care providers (such as Kaiser Permanente or the Department of Veterans Affairs) that have rolled out EHRs to thousands of clinicians throughout their organizations, and have used these systems in any consistent fashion for more than a couple of years.
Also, it's important to note that the HITECH Act -- and all its big brother-esque mandates that seem to bother a lot of people -- are also helping to put clinician training and ease of use of EHRs in a much brighter spotlight. Until now a lot of EHR complaints have focused on the software being too difficult for clinicians to use or clinicians not being properly trained on how to use important features.
I'm not saying that those are "the" reasons why EHR research from Stanford, Harvard, and other institutions has been disappointing to date. But those factors are contributors, just as other disruptive enterprise applications such as enterprise resource planning (ERP) or customer relationship management (CRM) have gone through growing pains in other industries.
The main difference now is that ERP, CRM, and other big-bang applications haven't been subsidized through government stimulus programs. Hopefully the government and its taxpayers will get a return on their multi-billion dollar investment in EHR incentive programs over time, and there will be evidence of better care, fewer medical mistakes, and less waste to prove it.