EHRs improve health quality: more compelling data

In a recent article that appeared in Health Affairs, David Blumenthal and others at the ONC published a review of the literature looking at whether use of Electronic Health Records (EHRs) made a difference in the quality of health care delivery.

We have been witnessing an unprecedented federal effort to move health care off of paper and onto a digital platform. Numerous programs, such as the CMS EHR Incentive Program (which earmarks incentive money to clinicians to “meaningfully use certified EHR technology”), as well as an increasing alignment of private insurance payors, specialty boards as well as state medical licensing boards, all point to encouraging (even demanding) the use of EHRs in day-to-day clinical practice.

But does this all make a difference in the quality of care? There have been some reports a few years ago that have looked at EHR use in hospitals and have found no measurable improvement in quality, overall. The new review by Blumenthal et. al. is a meta-analysis of peer-reviewed studies in the medical and health-policy literature, which showed that 92% of such articles concluded that Health IT had an overall positive effect on health care quality. This benefit was seen for all health care providers, not just the larger HIT “leader” organizations that have provided much of the data in the past.

There is also increasing public acceptance of this observation – a recent survey of 1,000 adults conducted by GfK Roper and Practice Fusion showed an overwhelming majority (3 in 4) believed that using a computer system provides them with better care.

One of the issues with reviewing published literature on the efficacy of EHR use and its impact on quality is that the systems that are studied are what EHRs have been, not what they are becoming. As a result of ONC Certification, EHRs are now required to build and offer Clinical Quality Measures and Clinical Decision Support as part of its core functionality.

The main reason, in past literature, that EHR use has been helpful (at least in a hospital setting) has been its tight connection with institutionalized quality-improvement programs. After all, simply creating lists of patients who need a particular chronic-condition-management intervention, or a wellness screening, is one thing – but, having staff to actually do something with those lists is another. It takes manpower (overhead expense) to call or contact patients and get them engaged with the health care delivery system. This is one place where a more coordinated team-based approach (e.g. Patient Centered Medical Homes) can excel in quality – such experience has been reported already.

As EHRs become more mature, ubiquitous and connected – and especially as EHRs are connected to patient-facing PHRs, and these PHRs are increasingly adopted – then the burden of outreach to patients needing contact will be easier. Pushing prompts out to patient-facing portals (web portals, or mobile apps) are a technology that should reach maturity over the next few years. These kinds of efforts should have a dramatic impact on improving measurable quality with HIT use. And the literature (which will always be retrospective, with often a 1-2 year lag period) will be yet-more-convincing down the road.

Robert Rowley, MD
Chief Medical Officer
Practice Fusion EMR