July 15, 2007

Quality Care by MDs, not EHRs

According to “Electronic Health Record [EHR] Use and the Quality of Ambulatory Care in the United States” from the July 9th issue of Archives of Internal Medicine, using EHRs in the out-patient setting does not appear to improve quality of care (as measured by compliance with 17 ambulatory care quality indicators developed at Stanford University). The retrospective study analyzed data drawn from the 2003 and 2004 National Ambulatory Medical Care Survey, an annual survey conducted by the CDC’s National Center of Health Statistics. During these two years, 18% of physician visits used EHRs and, when compared to physician visits without EHRs, the investigators found no statistical difference among the outcomes in 14 of 17 indicators.  
          Jeffrey Linder, MD, lead author and general internist at Harvard’s Brigham and Women’s Hospital, explained in an associated iHealthBeat article that, “…other studies have shown that [EHRs] are not much more than a replacement for the paper chart. In light of those findings, this is not that surprising…” Randall S. Stafford, MD, PhD, senior author and associate professor of medicine at the Stanford Prevention Research Center, offers his theories on why EHRs were not found to improve quality care: the study looked at older systems that probably lacked clinical decision support, and that “No matter how sophisticated the system, it can’t dictate a course of action to a physician…” For more on how the authors interpreted their study, see Stanford University’s press release. (Ed. note 07/19/07: For a different spin, see WSJ Health Blog’s Computerized Medical Files Not Much Better Than Paper, and the comments that follow.—ML)

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