Study Shows Little Benefit from EMR in Hospitals

People have been buzzing over a recent New York Times article (requires login, but you can get a login and password here) which discusses a Harvard study showing little benefit seen so far in Electronic Patient Records. The study is interesting and worthy of consideration. I think this part of the Times article summarizes the findings:

The new study placed hospitals into three groups: those with full-featured electronic health records, those with more basic ones, and those without computerized records. It then looked at their performance on federally approved quality measures in the care of conditions like congestive heart failure and pneumonia, and in surgical infection prevention.

In the heart failure category, for example, the hospitals with advanced electronic records met best-practice standards 87.8 percent of the time; those with basic computer records, 86.7 percent; and those without, 85.9 percent. The differences in other categories were similarly slender.

Reducing the length of hospital stays, according to many experts, should be a big money-saving payoff from electronic health records — as better care aided by technology translates into less time spent in hospitals. For hospitals with full-featured digital records, the average length of stay was 5.5 days; for those with basic computer records, 5.7 days; and those without, 5.7 days.

I’m sorry, but I have a real problem with studies like this. Just think about how many factors play into a hospital’s average length of stay. Would an EMR be on that list? I wouldn’t place it there. At least not anywhere near the top. The same could be said for the heart failure category as well.

I guess my point is that a study of hospitals like this is really hard. There are so many factors involved in the outcomes of a hospital that it is really hard to measure. Plus, no one should kid themselves into thinking that EMR is the end all be all. It is and will solve a number of major challenges, but it’s just one piece of the complex puzzle.

One could also make the argument that hospital EMR software even more than ambulatory care have basically been a substitute for paper processes. Hospitals have the extra money to customize the EMR like crazy so that it basically models the previous paper processes. The real innovation in these hospitals will start to happen now that they’re electronic. Instead of focusing on becoming electronic, they can now focus on optimizing their processes using technology.

Ambulatory practices are often faced with a reasonable amount of change when implementing an EMR since they don’t have the money or the clout to get the EMR customized. For those practices that select a well designed EMR this ends up providing a great ROI for the practice’s investment in EMR. Sadly, this is also likely the reason that the EMR implementation failure rate is so high. When done right, it’s a great experience with a great return for the practice. When done wrong it’s a disaster.

About the author

John Lynn

John Lynn

John Lynn is the Founder of the HealthcareScene.com, a network of leading Healthcare IT resources. The flagship blog, Healthcare IT Today, contains over 13,000 articles with over half of the articles written by John. These EMR and Healthcare IT related articles have been viewed over 20 million times.

John manages Healthcare IT Central, the leading career Health IT job board. He also organizes the first of its kind conference and community focused on healthcare marketing, Healthcare and IT Marketing Conference, and a healthcare IT conference, EXPO.health, focused on practical healthcare IT innovation. John is an advisor to multiple healthcare IT companies. John is highly involved in social media, and in addition to his blogs can be found on Twitter: @techguy.

10 Comments

  • I think the results of this study should come as no surprise. These “findings” are echoed by the vast majority of physicians that have not adopted EMRs or adopted then abandoned them. The doctors that don’t have EMRs will tell you the same thing “it won’t save me money and it won’t help my patients”.

    That’s why EMR and EHR needs a totally fresh look. The methodologies used to develop the mainstream EMRs are ones that result in bloated software that is built layer upon layer over several years or even decades.

    And that is why the HHS was wise to resist the pressure from HIMSS to accept the status quo and equate CCHIT certification with HHS certification.

    IMO, HHS needs to go further – further away from the path that EMR has been going down. “Meaningful use” should be linked to those two things (cutting costs and better care). If an EMR isn’t doing those things, then the stimulus money is just a waste.

  • It’s really sort of convoluted at this point. The cost cuts are supposed to trickle up – the practice or hospital saves money and therefore can charge less thus creating savings for the medicare and medicaid programs. So the stimulus says “invest in an EMR and the savings will follow”. But where is the data to support that idea?

    An accountant could “certify” whether or not an EMR/EHR system or other IT products and services are saving the practice/hospital money. So one way would be to have a pre-implementation audit and a post-implementation audit. IT projects that bring about savings are rewarded, others are not. One thing that would do is open things up – there are some practices right now that could cut their costs with IT projects other than EMR implementation. The stimulus does provide some grants for these “other” types of projects but by far the emphasis is EMR.

    Similar audits can be a applied to patient care through reporting. EMR software is not required to do this type of reporting – it just makes it easier.

    I work with smaller practices and I think that world is very different from the hospital world. What I am saying is that each practice ought to be able to shape their own path to cost savings and better patient care and then be rewarded based on RESULTS.

  • Russ,
    Even audits are prone to a lot of manipulation. A part of me thinks that they maybe should have just given the money out with few stipulations.

  • The government uses incentives to direct behavior. For example, I just bought a dishwasher that is EnergyStar rated because I am going to get a tax credit for doing so. The higher price that I paid is partially offset by the tax credit and supposedly the rest is offset in water and energy cost savings.

    Now imagine if a study showed that EnergyStar products are not more efficient than the non EnergyStar products.

    A part of me thinks that government should not need to pay incentives at all – but if they are going to, I hope that they are designed to bring about the desired results.

  • Russ,
    EMR adoption is the goal for me. So, just have them show proof of the purchase of EMR software and implementation of that software. Then, just audit a certain number of them to ensure that they bought the software. The fear of an audit will keep most people honest. It won’t satisfy all, but would be simpler to administer and more effective.

    Granted, this is all after the fact. The legislation is what it is and the real question is how can we make the most of what’s been done.

  • you’re right, the real success will be about a year down the road when the electronic systems are optimized and all the bugs are worked out. otherwise, it’s not worth the money, according to these stats.

  • The real questions are:

    1) if the benefits of EMR are so difficult to measure, then why is our government subsidizing the entire industry?

    2) why is the government (justice department) standin by idly as EMR providers like EPIC and Cerner crowd out otherco panties that are innovating to make the EMR value proposition more tangible?

    3) If the data that computerized medical records produce is the ultimate key to long term returns on our nation’s massive investment, then why are companies like Epic and Cerner allowed to hoard the data and not share it? It seems to me that if taxpayers are going to subsidize the industry and mandate implementation that we should demand better than the behavior of the industry’s oligopolists.

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