E-Health Records No Quick Fix

Study says electronic health records alone have limited ability to control costs or improve quality, at least in the short term.
A new report suggests that electronic health records may not substantially contribute to increasing efficiency, reducing costs, or improving patient outcomes, at least in the short-term.

Published in the April issue of Health Affairs, the study, which was conducted by Harvard researchers, specifically assessed whether EHR adoption was associated with better performance on standard process-of-care measures; lower mortality and readmission rates; shorter length of stay; or decreased inpatient costs. At best, the findings showed that EHRs had contributed to marginal improvements in some areas, but generally lacked statistical or clinical significance in others.

"Our findings suggest that to drive substantial gains in quality and efficiency, simply adopting electronic health records is likely to be insufficient. Instead, policies are needed that encourage the use of electronic health records in ways that will lead to improvements in care," the report said.

The study received responses from 3,049 hospital CIOs or equivalent IT managers in the 50 states and the District of Columbia.

Among the findings were:

There was no significant relationship between EHR adoption and quality process measures for acute myocardial infarction, congestive heart failure, or pneumonia.

The report found no relationship between the level of EHR adoption and overall risk-adjusted length of stay.

An analysis of length of stay for individual conditions found that patients with pneumonia in hospitals with a comprehensive EHR system stayed in the hospital, on average, 0.5 days shorter than patients in hospitals without EHR systems.

Hospitals with comprehensive EHR systems had similar rates of readmissions within 30 days of hospital discharge compared to hospitals with basic or no EHRs.

Overall, hospitals with EHRs had comparable inpatient costs to hospitals without them.

The availability of computerized physician order entry for medications and individual clinical decision-support tools -- clinical reminders and clinical practice guidelines -- was generally associated with marginally better performance on each of the Hospital Quality Alliance quality metrics.

"We are still in the early days of electronic health record adoption, and there's little evidence for how best to implement the technology to make the greatest gains," said Catherine DesRoches, PhD, an assistant professor of medicine at Harvard Medical School, who led the study. "Hospitals may not see the benefit of these systems until they are fully implemented, or it may take many years for benefits to become apparent."

While the report emphasizes that EHRs are at a nascent stage in their development, the report lauds the mandates issued under the American Recovery and Reinvestment Act that propose meaningful use rules which focus on several basic attributes, including adoption of certified EHR systems, as well as the ability to engage in electronic prescribing, exchange information, and report on clinical and other quality measures selected by the Health and Human Services secretary.

"In our view, these findings underscore the appropriateness of the proposed rules, which manifest a dynamic and rigorous approach to defining meaningful use, with expectations rising over time as providers become accustomed to the technology," the report said.

The report relied on information drawn from the 2009 Hospital Quality Alliance data which reported process measures related to the care of acute myocardial infarction, congestive heart failure, pneumonia, and prevention of surgical complications. Researchers also used existing research from the 2008 American Hospital Association survey of IT in U.S. acute care hospitals, the 2008 AHA annual survey, and the 2006 Medicare Provider Analysis and Review File.

"Our findings suggest that hospitals need to pay special attention to how they implement these systems. Simply having the technology available is probably not going to be enough," said DesRoches. "Hospitals will need to effectively integrate new systems into their current practices. Studying institutions that have been successful will provide important lessons for everyone."