Quality focus, coordinated implementation needed to realize benefits of EHRs

Those in the healthcare system will need to focus on quality control and coordinated implementation to realize the potential of electronic health records (EHRs) and clinical decision support (CDS) software to improve clinical care, according to the authors of research published online by the Archives of Internal Medicine.

“In the absence of governmental impetus and standards, current adoption patterns may have fostered incomplete implementation and use of less effective technologies,” write senior author Randall S. Stafford, MD, PhD, associate professor of medicine at the Stanford University School of Medicine, and Max J. Romano, a former Stanford University undergraduate student. “Systematic federal intervention through [the Health Information Technology for Economic and Clinical Health Act] may be needed to realize the potential of these technological advances.”

The researchers found that the use of EHRs, with or without CDS software, did not result in improved clinical care in the outpatient setting, in an analysis of 2005-2007 physician survey data from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey.

When the investigators compared visits that involved EHRs with those that did not, they found that physicians using EHRs had better performance in one of 20 indicators, diet counseling in high-risk adults, compared with physicians who did not use EHRs. The use of EHRs with CDS improved performance in one of 20 indicators, lack of routine electrocardiographs ordering in low-risk patients, as compared with EHR use without CDS. Otherwise, quality did not vary between visits that included EHRs and those that did not.

The investigators suggested that additional research is needed to determine why CDS software seems to be beneficial in clinical trials at academic medical centers but not in the smaller outpatient settings where the majority of Americans receive their care.