Researchers: EHR Doesn’t Improve Care

January 28th, 2011

Two researchers at Stanford University, Palo Alto, Calif., say their research shows the use of electronic health records (EHRs) doesn’t improve the quality of care after all, countering one of the major arguments for adoption.

The three year study of data from 250,000 patient visits in 2005 through 2007 looked at whether computerized, clinical decision-support tools in EHR systems improved quality of care. The researchers report in “Electronic Health Records and Clinical Decision Support Systems: Impact on National Ambulatory Care Quality,” published online in the Archives of Internal Medicine that there was “no consistent association between EHRs and clinical decisions and better quality … These results raise concerns about the ability of health information technology to fundamentally alter outpatient care quality.”

Senior author Dr. Randall Stafford, of Stanford, who worked with undergraduate student Max Romano, says in a Stanford press release, “There’s a lot of enthusiasm and money being invested in electronic health records. It makes sense, but on the other hand it’s an unproven proposition. When the federal government decides to invest in healthcare technology because it will improve the quality of care, that’s not based on evidence. That’s a presumption.”


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17 Responses to Researchers: EHR Doesn’t Improve Care

  1. Heather Says:
    January 29th, 2011 at 3:23 pm

    I disagree whole heartedly with this new study. The adoption of EHR’s will improve quality of care as more and more physicians use the system. For physicians to have access to a patients consult notes, x-rays, labs, and records from other providing physicians at the touch of a button will help in diagnosing and prescribing for patients more accurately. The slow adoption of EHR technology added to the slow process for the individual states to build secure health information exchanges are the reason no one is seeing progress yet. As physicians sign up so that they can receive their cut of the ARRA money we will start to see huge improvements across the board. Unfortunately, for the time being, nay sayers will publish reports like this to negate progress.

  2. Marcy Says:
    February 2nd, 2011 at 12:30 pm

    I have heard both side and what I have been hearing is EHR takes away the personal touch. Healthcare workers are looking at a computer instead of looking at the patient and making eye contact. Patient like the face to face visit.
    As far as improvving care it will only work as effectively as the operater uses it.

  3. Tabatha Marlow Says:
    February 2nd, 2011 at 1:24 pm

    I agree with Marcy. Healthcare is all about that one on one interaction. If the nurse is dragging a computer to the bedside of all her patients is she really giving that personal attention that most patient’s are looking for. As a coder, I have seen the downside to having EHR pertaining to documentation. Things from mispelled words due to voice recognition to incomplete records from one system to another. I miss the days I could pick up a paper chart and flip to just what I was looking for.

  4. Lori Says:
    February 2nd, 2011 at 1:41 pm

    I agree with Marcy—a technological tool is only as good as the user and the data entered into it. There is generally quite a gap (ie. Grand Canyon) between a technology’s theoretical potential and its actual efficacy in real-life use by human beings.

    In theory, an EHR makes perfect sense and would increase efficiency, information flow, quality of patient care, etc. However, as we all know, real-world application of EHR includes human error, inaccurate data input, unforeseen technical hurdles, and increased potential for malicious use of the electronic info itself. Also, it seems that a provider must focus a certain additional amount of attention on the process of entering medical record documentation and other data appropriately onto the EHR. This could potentially cause the provider to be somewhat distracted from the clinical and emotional needs of the patient at hand, without being conscious of it.

    Regardless, the United States has embarked on the EHR era, and only time itself will reveal what effects EHR will truly have on quality of care as well as the other aspects of our healthcare system.

  5. T Lichauco Says:
    February 2nd, 2011 at 2:00 pm

    The EHR can be good for finding specific data that I know should be there.
    It is bad for entering data – a real pain
    It is bad for perusing a chart – too much junk / worthless information is stored
    screen size is too small to scan the record with my minds eye!
    I actually don’t trust ours — data not tagged properly gets lost!

    Overall, I think care outcome is worse with our new EHR which is built from antique technology.

  6. Stacee Says:
    February 2nd, 2011 at 2:47 pm

    I think it’s a big pain. We are going electronic right now, and the consults will only be in the computer if we scan them in. It’s really been a huge disappointment in my eyes on how much we will have to scan in or still do manually.

  7. debra Says:
    February 2nd, 2011 at 3:34 pm

    IN MY OPINION, EHR IS JUST ONE MORE WAY FOR HACKERS TO BREAK IN THE SYSTEM AND GET EVERYTHING THEY NEED ON A PATIENT…..I FOR ONE WOULD RATHER HAVE MY MEDICAL RECORDS IN A SAFE SECURE BASEMENT, THAN STORED IN A COMPUTER THAT ANY ONE WITH A BRAIN COULD HACK INTO……..THE GOOD OLE DAYS!!!!

  8. Tracey Says:
    February 2nd, 2011 at 4:01 pm

    “Junk in is junk out” You guys are cracking me up. We are in a world that thrives on the advancement of technology and you would rather have a “scratched” piece of paper that the MD has written orders for some of the advanced tests we are able to perform and at the same time when that same MD would like to write a paper and needs five years worth of data pulled who is going to go page by page to pull that data? This article is written based on information that is over three years old. I agree with Heather. Guess what guys, we have moved your cheese into a different room you may stay where you are and whine about it or you can find your way to the new room. Either way change happens….read the writing on the wall.

  9. Laura Says:
    February 2nd, 2011 at 5:06 pm

    I think a lot of good can come out of the use of EHR’s, from a payers perspective however, I see another huge way to commit fraud by a provider (on purpose or not). Point and click gets you higher reimbursement!Auditing a record is nearly impossible because of the Point and click ability, all of the records look exactly the same and there is simply no easy way of verifying if the provider actually provided the level of service he is claiming that he did.

  10. Barb Says:
    February 3rd, 2011 at 6:59 am

    The challenges with EHRs is nothing new. Elements like purchasing old technology, lack of understanding of the entire process (what data, who needs it, reporting requirements, ease of use, etc.) and worst of all, trying to communicate with equally old and disparate systems. For those who remember when computer technology first came to health care- usually the Finance Dept. chose the system- great for them, no one else, then every other software module had to be tacked on. We apparently haven’t learned much. That said, EHRs will evolve. Efficiency will improve first but translating that to actual improvement of care…we’ll see.

  11. Dale Says:
    February 3rd, 2011 at 9:06 am

    A world that thrives on the advancement of technology doesn’t make it happen or even make it good. And even in some cases proves to be a step backward. With government intervention into healthcare you can rest assured that it will be an expensive proposition with little gain. The government has already come out and said they under estimated the cost of EHR. And now they want to pass a kill-switch regulations on the internet. Can you imagine what disaster that will create to EHR in the event kill-switch is activated?

    And remember when the government did that HIPAA thing. Remember how expensive that was. There was a whole new industry created to handle the massive paper work. How ironic that is when we’re supposed to be so green conscious. The use of common sense would have been more practical.

    The problem with EHR is providers abuse the copy and paste. You have a patient coming in with a productive cough and congestion and the ROS says the lungs are clear. I see it all the time. Or the records are just not updated.

    If EHR is to happen, so be it. But it should be a provider/facility choice; not a government mandate where those that comply are rewarded with taxpayers’ money of those that have no desire to follow the herd.

  12. Laura Says:
    February 3rd, 2011 at 2:16 pm

    I do auditing for a large group of Family Practice specialist. The doucmentation is going up the “quality” is not only not been improved it has gotten worse. And yes a EMR is only as good as the user, and the ability to make a template. I just want to believe that I along with all other patient are more then a template. I see them working harder to make sure that documentation meets requirments, then documentation that anyone can follow up with.

  13. Yvette Says:
    February 4th, 2011 at 5:33 am

    EHR is great for everyone involved! No, a provider doesn’t drag a computer to the bedside of patients, and there’s still face to face encounters. The EHR is replacing the paper not the provider. All provider/patient interaction is the same. It’s just that they’re documenting electronically rather than on paper. Therefore when you see a different provider, no need to get a copy of your med. records… they have them. As far bad documentation…can’t blame that on the EHR…talk to the provider (whose handwriting may not be legible anyway!). Once everyone is on board with this…It will be an outstanding tool!

  14. Laura Says:
    February 6th, 2011 at 2:53 pm

    EHR is definitely a positive step for health care. As with any technology, there is a learning curve and transition period that really sucks. But once you get on the other side of that transition, you wonder how you ever lived without the new technology.

    Seeing a new patient will no longer mean having to depend on the patient’s memory for what their medical history is. With a few clicks of a mouse, a doctor will be able to obtain all the medical information he needs to make informed decisions about a patient’s care. And the ability for a patient to carry their medical record on a flashdrive while they travel, has great peace of mind, especially for seniors or anyone with multiple health issues.

    As Yvette said, “the EHR is replacing the paper, not the provider.” A good provider will still provide the human contact essential for good health care. The only thing changing is how he documents that encounter and who will have access to the information in the future.

    Let’s keep working together to find ways to improve this advancement and use it to it’s fullest potential, instead of burying our heads and wishing we could go back to the good old days. We live in a technology, information-driven world now, and health care must join this advancement.

  15. ValSue Says:
    February 7th, 2011 at 7:43 am

    It has been known for years in the health IT side that the EHR does not currently result in measurable improvement of quality. The EHR is a decent media for multiple user access and crunching data to analyze particualar outcomes and predict futures trends, but this is why there is now such a large focus on “meaningful use” of the information. It’s not enough to store and retrieve data, which is what the past decades of EHRs were doing.

    Offices who want assistance in deciding on the best EHR for *them* should contact their federally designated Health IT Regional Extensions Centers (REC) who will charge a nominal ($500) flat fee in analyzing the practice flow, questioning vendor proposals, and help in EHR selection process ASAP in order to qualify for meaningful use federal incentives.

  16. Christian Lehinger Says:
    February 23rd, 2011 at 8:59 am

    Simply put, taking a paper based process and paper based documentation style into an electronic world will not work. It is unfortunate, but MOST EHRs are written in this manner. They are all about narrative generation and they are source based (having items grouped by type of data). Let me geek-out for a moment…
    To see real improvement we need to focus on the way scientists really think; Measure, Observe, Repeat. Data must be displayed and collected as symptoms over time; yes narratives can be generated but that is a secondary outcome. In addition, charts must be problem based. ie. Here is the problem, this is what has been done, and here is what needs to be done in the future.
    We also need usable interoperability. Just having data is not good enough because it produces information overload (too much info= ignore the info). Usable interoperability means that the relevant data is available when and where it is needed. This can only be accomplished through the use of a standard coded language.
    To loosely quote Francis Bacon ~ It is vain to expect any great progess in the sciences by engrafting new upon old. Resolving an issue forever requires a rethinking of the very foundations.

  17. Sherri Says:
    April 19th, 2011 at 4:13 am

    As a nurse, I don’t agree that EHR will improve quality of care. Nurses have been using computers to document patient care for years. It does not compromise patient care, it is just another way of capturing all of the documentation that has to be done anyway, no matter if it’s handwritten or by data entry, but it does force documentation of some data that may have been overlooked by the provider of services. Quality of care depends on the person who is providing care: his skills and knowledge, accuracy of observations and ability to interpret whatever data is presented to him/her regarding the patient. EHR provides easier access and consistency in documentation for the professional staff, not necessarily improved healthcare for the recipients. I can also see another downside in EHR: there are more physicians than you’d care to think about who are not great diagnosticians. I often encouraged patients to seek a second medical opinion by taking their test results to another MD who was not associated with the his physician’s practice or group. Having full access to all of the past medical records can severely limit and compromise the type of care and response a patient could receive from some practitioners.

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