Electronic Health Records: Are They Worth It or Not?

The debate in the US over the value of electronic health records got turned up another notch the past few weeks as competing studies seen to indicate that EHRs improve the quality of healthcare as well as don't.

On the positive side of the ledger, a RAND Corporation study released in October claims that, "Routine use of electronic health records may improve the quality of care provided in community-based primary care practices more than other common strategies intended to raise the quality of medical care."

"Studying 305 groups of primary care physicians in Massachusetts, researchers found that practices that used multifunctional electronic health records were more likely to deliver better care for diabetes and provide certain health screenings than those that did not."
 
"'Overall, we were surprised by how few strategies to improve the quality of care were linked to measurably better performance,' said Dr. Mark W. Friedberg, the study's lead author and an associate natural scientist at RAND, a nonprofit research organization. 'The strategy that showed the most impact was use of advanced electronic health records.'"
 
Then there was a story on how a Kaiser Permanente-led study, published in the American Journal of Managed Care, found that "A simplified method for bundling fixed doses of a generic statin and an ACEI/ARB was successfully implemented in a large, diverse population in an integrated healthcare delivery system, reducing the risk of hospitalization for MI and stroke."

As pointed out here, the data mining of Kaiser-Permanente's hospitals' electronic records helped find patients for the study and also helped researchers track their progress.

The secondary use of EHR patient data through data mining also got big, positive reviews the past few weeks as well. First, there was a report by PricewaterhouseCoopers LLP that found 76% of healthcare executives surveyed felt that all the data being collected in their EHR systems was going to be their organization's greatest asset over the next five years. It also found that the executives only felt they could recoup their investments if they could exploit that information in some way (read that to mean financially).

Helping that idea along was the announcement in October that Kaiser-Permanente was awarded $54 million by the National Institutes of Health to sift its databases to study inks between genes and conditions such as heart disease, obesity, diabetes and aging.

And then there was this article a few days ago in the Christian Science Monitor that states that tucked away in five paragraphs in the 2,074 pages of health care reform legislation in the US Senate are 5 paragraphs that would require basically everyone in the US to have an EHR that is able to be data mined at will by the government without needing anyone's consent.

I don't know whether Kaiser-Permanente asks for its patients' consent before their information is data mined, or if that is a requirement of their health care plan. I do know the Mayo Clinic requires consent before it makes use of the patient information resident in its EHR system, which I think is the only ethical thing to do.

On the negative side of the EHR ledger there was an article in October in the Washington Post that showed EHR systems are not all what they cracked up to be. The article said that EHR systems "can increase errors, add hours to doctors' workloads and compromise patient care." The article cited cases of each. The Post also said that 20 percent of physician groups in Arizona that have EHR systems are removing them.

Then last month, there was a story in the New York Times that said a study led by Dr. Ashish Jha and Catherine DesRoches of Massachusetts General Hospital,  "comparing 3,000 hospitals at various stages in the adoption of computerized health records has found little difference in the cost and quality of care."

This study examined hospitals who have advanced EHRs, those possessing more basic EHRs, and those without EHRs. It then looked at their performance on federally approved quality measures in the care of conditions like congestive heart failure.

In comparing hospitals in regard to heart failure, the hospitals with advanced EHRS met best-practice standards 87.8 percent of the time; those with basic EHRs, 86.7 percent; and those without, 85.9 percent. The differences in other health categories were similarly marginal.

Last week, a Harvard Medical School study confirmed these findings. This study examined computerization’s cost and quality impacts using a diverse national sample of 4000 hospitals over a four year period and found that EHRs and other related health information technology has had only a modest impact on process measures of quality, but no impact on hospital administrative efficiency or overall costs.

One of the study authors, Dr. David Himmelstein, told ComputerWorld that during the course of their study they found that the most successful EHR systems don't require users' manuals or much in the way of training. I note this because the U.S. Department of Health and Human Services last week announced $80 million in grants for new workforce training programs in order to speed the adoption of EHR systems across the US. More training money is in the pipeline.

Given that EHRs are being touted by US government officials as a way to significantly improve the quality and reduce health care administrative costs (including saving Medicare), the data don't look so good for achieving either of these objectives.

However, I doubt that any number of studies showing problems with EHRs is going to make much of a difference, especially now that the Administration has $19 billion to bribe doctors and hospitals for EHR adoption.

Unfortunately, given the current political environment in which both Democrats and Republicans think EHRs are a panacea for what ails the US health care system, the US will likely end up with a clunky, costly kluge of a national EHR system that will not do anything for health care quality or cost control, but which will have to be over time completely rebuilt at great cost in both financial terms and patient care.

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