Study Ignores Other Benefits of Electronic Health Records

I’ve now had two people send me links to a study coming out of Stanford University that says that EHR software doesn’t improve patient care in the US (Here’s one story about it from Reuters). So I figure that it must be a topic that my readers would enjoy me discussing. Here’s a portion of their summary:

A team from Stanford University in California analyzed nationwide survey data from more than 250,000 visits to physicians’ offices and other outpatient settings between 2005 and 2007.

They found electronic health records did little to improve quality, even when there was “decision support” software that gives doctors tips on how best to treat individual patients.

I’ve always found it a bit off to talk about EMR software as a means to improve the quality of care that a doctor provides. For the vast majority of healthcare, more information, clinical decision support, drug to drug interaction checking, drug to allergy checking, etc aren’t going to improve the care a doctor provides. First, because the doctors have been well trained to do many of these things already. Second, because if I come in as a generally healthy patient with a common cold, then of course the doctor doesn’t need any of these advanced EMR functionality.

Now in more advanced and complicated cases, there is potential that an EMR software could offer some benefit. I remember a doctor commenting back in 2009 on my blog about how the Body of Medical Knowledge could become to complex for the human mind to process it all. Whether we’re there or yet, is open for debate, but the concept is interesting. Although, this still only applies to the outlier cases.

I remember one time hearing a clinician tell me about how the Drug to Drug interaction alerts informed her of some medical knowledge that she hadn’t known previously. So, there are instances where various parts of an EMR software can provide better patient care, but is it dramatic enough difference to really improve the quality of care? I think that’s a hard argument to really make. At least with the current iteration of EMR software.

Other EMR Benefits
Quality of Care aside, I think the thing that studies like this (and their related headlines) miss is the other benefits of having an EMR system (see also my list of EMR benefits in my EMR Selection e-Book).

I can’t tell you how many times I’ve heard doctors talk about how they love the legibility and accessibility of patient charts in the EMR. No difficult to read handwriting (others or their own). No waiting for chart pulls. These are guaranteed benefits to having an EMR system. Sure, it’s hard to quantify them when it comes to dollar signs or improved quality of care. However, they’re a real tangible benefit to having an EMR. Not to mention that I still think there’s long term benefits to widespread adoption of EMR that we can’t even imagine yet.

I could go on about many of the other benefits. It’s just unfortunate that studies and those who report on these studies don’t take into account these other benefits of EMR software.

UPDATE: Over at HIStalk, Mr. H also points out that the study only focuses on a couple quality measures. So, it doesn’t actually say that EHR doesn’t improve quality of care, but instead it says that it doesn’t improve quality of care when it comes to the couple simple measures that the study used to measure it. There could be many other quality measures where EHR does improve the quality of care. We just don’t know.

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.

11 Comments

  • packets,
    It is worth pointing out that the study you link is focused on hospital EMR implementations. Ambulatory EMR implementation is a different world.

    We actually have a post planned for http://www.emrandehr.com which will be posted shortly that talks about another Accenture study about hospitals not being ready for meaningful use. There’s a reason I like to work in ambulatory EMR and not hospital EMR as much.

  • To me a more essential problem is that when you read the details, this study only defined quality of care as whether the doc followed the book more often when there was an EMR present!

    (Specifically the 20 measures used were about whether the right med or treatment was prescribed. I can’t imagine how installing an EMR would affect that.)

    Maybe I’m missing something, but I think that’s an absurd way to assess the impact of installing and using an EMR.

    As a side note, there’s the outmoded practice in healthcare of defining quality as “doing what the book says you should.” No other modern industry views it that way – that was how, 40-50 years ago, America made crappy cars. Installing computers there wouldn’t have impacted quality, either.

  • I thought the whole push to EMR’s was to lower the cost of healthcare across the board by increased system efficiency thus improving the quality of care for all.
    Now we’re beginning to discover the cost and time to implement EMR’s is off by 100% of predicted, and any improvement in quality of care might not be realized.
    Easy…redefine “quality of care” full steam ahead and then let’s see where we are in 10 years. It’s only money and lives.
    Besides, it’s a mandate, right? Make it work people…

  • When it comes to proving ROI on an EHR, too many times poor comparisons are made.

    First, you just can’t compare a hospital implementation to a private practice implementation.

    Second, ROI…what are you really measuring? Do you include government reimbursements in your ROI (if you ever see them)?

    Third, how do you really measure a quality of care improvement?

    As an electronic-centric person, if I were a doc, I’d have been on an EHR years ago.

    BUT, most EHR’s stink. Most EHR implementation stinks. And guess what? Usually cost goes up.

    As mentioned above, one of the greatest things about an EHR is the access to info. Granted, if there isn’t an HIE in the region…that probably won’t be a benefit. Medicine mix-u- prevention is another potentially huge improvement.

    Most articles I’ve seen focus on hospitals. I don’t focus on hospitals myself…and what is important to a hospital is generally different that what a private practice focuses on.

  • I have had experience using EMR/EHR as well as having to use the old school paper charts. I’m not a physician, but I worked in the business office for various physician practices doing billing, coding and collections. Granted, the physicians know (for the most part) the drug interactions, etc, unless possibly there is a very complex case. When it comes to ease and accessibility with the charts, there is just no comparison. There is no more hunting down charts, you can read everything in there; the information is legible and organized. In the case of a malpractice suit, there is no need to worry about not being able to see/read what is written in the chart. Everything is clear and date-stamped. As far as the billing is concerned, we are able to abstract the information easily and get the claims out the door much faster than before. The visits are organized into the SOAP format, diagnoses and procedure codes are put into the system.

    All of this aside, physicians are also able to access patient information from their homes, which is a huge asset when they are on call. Many also have the ability to log into the hospitals and view patient records (x-rays and such as well) from their homes when they are on call as well. All of this works in their favor when they are on call.

    After working for a short time doing billing for the practice without the EMR, I would never do it again. It was disorganized, illegible, and basically a disaster. I cannot imagine having a practice without having this implemented, even with the cost that I know is involved.

  • Thanks for everyone’s perspective. A lot to chew on for sure.

    I’ve always hated how people so rarely differentiate between a hospital EMR and clinic EMR. They are such different beasts even if there’s some underlying principles that are the same.

  • What the study misses is the opportunity to use EHR’s it improve POPULATION health. In conjunction with specific improvement objectives, EHR’s can be powerful and effective. For example, using its EHR, VistA, both to send clinical reminders and to measure results, VA dramatically improved its rate of administering flu vaccine and pneumonia vaccine. VA used the combination of EHR and clinical performance measures to drive a wide array of improvements. Looking at individual outcomes alone misses the great power of EHR’s.

  • Okay, let’s see:
    1. Better patient outcomes? No.
    2. Improved efficiency? Nope.
    3. Cost savings? Nope.
    4. Improved morale of providers? No.
    5. Patient safety improvements? Nope.
    6. What about just making doctors follow guidelines? Nope, not even that.

    But wait! Improved legibility! That’s good.

    This discussion reminds me of the research on amiodarone in cardiac arrest. No benefit to outcomes, but you’re slightly more likely to survive to a persistent vegetative state.

    I am seeing is the unwelcome intrusion of IT into our workflow at a time when the available products are not mature or flexible enough to accommodate our needs. A lot of things we have done at the behest of regulators, which seemed like really good ideas, have been disasters. (Food pyramid anyone?)

    Someday the software will be better. And then the market will decide.

  • As a person who has reviewed hundreds of patient records, both EMR and handwritten, for medical-legal purposes, I have to say that many portions of the EMR are next to useless for retrospective study purposes. Once printed out, they are just as illegible as the handwritten ones are – because of very small print or awkward organization. This goes back to the mindsets of the developers. There are many things that need to be done to make EMRs more user-friendly AND more reader-friendly.
    I might add that both prosecution and defense have similar problems with EMRs. They are a long way from what they need to be.

  • Elizabeth,
    I find the irony in you printing out an electronic record pretty funny.

    This said, I agree that poorly done EMR documentation can put you in just as much liability risk as a paper record. A topic which I’ve written about dozens of times on this site.

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