EMRs Don't Always Translate to Better Care in Hospitals

Use of electronic health records by hospitals across the United States has had only a limited effect on improving the quality of medical care, according to a RAND Corporation study.

In a study that included a wide variety of hospitals nationwide, researchers found that hospitals with basic EHRs demonstrated a significantly higher increase in quality of care for patients being treated for heart failure. However, similar gains were not noted among hospitals that upgraded to advanced EHR systems, and hospitals with EHRs did not have higher quality care among patients treated for heart attack or pneumonia.

The findings, published in the American Journal of Managed Care, are part of a growing body of evidence suggesting that new methods should be developed to measure the impact of health information technology on the quality of hospital care.

"The lurking question has been whether we are examining the right measures to truly test the effectiveness of health information technology," said Spencer S. Jones, the study's lead author and an information scientist at RAND. "Our existing tools are probably not the ones we need going forward to adequately track the nation's investment in health information technology."

The RAND study is one of the first to look at a broad set of hospitals to examine the impact that adopting EHRs has had on the quality of care.

In the study, which included 2,021 hospitals, researchers determined whether each hospital had EHRs and then examined performance across 17 measures of quality for three common illnesses, including heart failure, heart attack and pneumonia.

During the study period, which spanned from 2003 to 2007, Jones and colleagues found that the number of hospitals using either a basic or advanced electronic health records rose sharply during the period, from 24% in 2003 to nearly 38% in 2006.

Researchers found that the quality of care provided for the three illnesses generally improved among all types of hospitals studied from 2004 to 2007. The largest increase in quality was seen among patients treated for heart failure at hospitals that maintained basic EHRs throughout the study period.

However, quality scores improved no faster at hospitals that had newly adopted a basic EHR than in hospitals that did not adopt the technology. In addition, at hospitals with newly adopted advanced electronic health records, quality scores for heart attack and heart failure improved significantly less than at hospitals that did not have EHRs. Electronic record systems had no impact on the quality of care for patients treated for pneumonia.

Researchers say the mixed results may be attributable to the complex nature of care. Focusing attention on adopting EHRs may divert staff from focusing on other quality improvement efforts. In addition, performance on existing hospital quality measures may be reaching a ceiling where further improvements in quality are unlikely.

New performance measures that focus on areas where EHRs are expected to improve care should be developed and tested, according to researchers. "With the federal government making such a large investment in this technology, we need to develop a new set of quality measures that can be used to establish the impact of electronic health records on quality," Jones said.

Source: RAND Corporation