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.