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12-06-2011 | Medical management | Article

Electronic health records fail to improve outpatient care


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MedWire News: Study findings question whether the use of health information technology improves the quality of outpatient care.

Electronic health records (EHRs) failed to improve clinical care via the use of clinical decision support (CDS) and electronic guideline-based reminders and alerts, Max Romano and Randall Stafford (Stanford University, California, USA) report in the Archives of Internal Medicine.

The results also "raise doubts about past implementation of costly EHR technologies nationally," they say.

In an editorial accompanying the analysis, Clement McDonald and Swapna Abhyankar (National Institutes of Health, Bethesda, Maryland, USA) called the results "dismal," and questioned whether data from clinical trials showing benefit of CDS systems can be translated to the national level.

That said, the editorialists "suspect that the EHR and CDS systems in use at the time of their study were immature, did not cover many of the guidelines that the study targeted, and had incomplete patient data."

The analysis, based on two large US physician surveys on ambulatory patient visits, evaluated physician performance on 20 quality indicators.

EHRs were used in 30% of an estimated 1.1 billion annual US patient visits, with CDS systems in place in 57% of the EHR visits. The CDS is a feature of the EHR that alerts, reminds, or directs healthcare practitioners based on clinical guidelines.

Of the clinical quality indicators, just one of the 20 variables - the use of diet counselling in high-risk adults - was significantly better in the EHR visits when compared with non-EHR visits (odds ratio 1.65).

Similarly, among the EHR visits, only one of 20 quality indicators was significantly better in visits with CDS compared with EHR visits without CDS. In this case, physicians were less likely to order routine echocardiographic screening in low-risk patients.

"There were no other significant quality differences," write Romano and Stafford, adding that these data refute the hypothesis that CDS would be associated with improved quality of care.

The findings suggest a need for greater attention to quality control and coordinated implantation to maximize the potential of EHRs and CDS for the improvement of health care, report the researchers.

MedWire ( is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2011

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