EHRs ‘no answer’ to care crisis

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The introduction of electronic health records failed to boost the level of care delivered in routine doctor visits, a study has found.

Of 17 measures of quality assessed, electronic health records made no difference in 14 measures, according to a study published in the Archives of Internal Medicine.

The study by researchers at Stanford and Harvard Universities was based on a survey of 1.8 billion physician visits in 2003 and 2004. Electronic health records were used in 18% of them.

Experts routinely state that electronic records can cut costly medical mistakes, but few studies have evaluated whether the records improve the level of care when compared with paper records.

"Our findings were a bit of a surprise.," said Dr. Randall Stafford of Stanford University. "They really performed about the same."

The 14 quality indicators for which electronic records made no significant difference included such factors as prescribing recommended antibiotics; diet and exercise counselling for high-risk adults; screening tests; and avoiding potentially inappropriate prescriptions for elderly patients.

The two indicators that improved with use of electronic health records were avoidance of benzodiazepines for treating depression and omitting urinalysis as a routine screening test. But when it came to statin therapy, physicians using electronic systems fared worse than their peers with paper records.

In a secondary analysis limited to visits to primary care physicians or cardiologists, there was improvement in one other indicator with EHR use: smoking cessation counselling was given more frequently.

"We need to be cautious about the assumption that electronic health records are going to solve problems around healthcare quality by themselves," Stafford said. "It's not sufficient to just have an EHR system that provides decision-making guidance. Physicians have to be willing to act on that input."

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