EHRs don't necessarily produce higher quality

A pair of recent studies has found that the computerization of medical practice doesn't necessarily lead to better care.

An Archives of Internal Medicine study (Linder, et al.) looked at a cross-section of patient visits in 2003 and 2004, focusing on 17 quality indicators. On 14 of those measures, the researchers found, "there was no significant difference between visits with vs. without EHR use." On two of the other indicators, performance of practices with EHR was better, and on one metric—prescribing of statins to patients with hypercholesterolemia—EHR users did significantly worse.

The other study, published in Annals of Family Medicine (Crosson, et al.), measured the adherence to diabetes guidelines of 50 practices engaged in a quality improvement project. At the end of the study period, there was room for improvement in all of the practices. But the practices not using an EHR were more likely to meet the guidelines than those with an EHR. The authors concluded, "The use of an [EHR] in primary care practices is insufficient for insuring high-quality diabetes care."

The researchers recommended that practices "encourage a culture of improvement and quality within their practices and work to develop methods to improve diabetes care before implementation of an [EHR]." Both they and the authors of the Archives of Internal Medicine paper also pointed out that many of the EHRs in physician offices lack basic decision support and quality improvement functions such as chronic disease registries and the ability to prescribe electronically and receive lab results online.

Of course, the reason why so many EHRs don't have such features is that quality improvement isn't the main reason physicians acquire EHRs. Rather, as consultants and medical society executives point out, most doctors buy EHRs to increase their efficiency and improve documentation. And even if they were reimbursed at a higher rate for better care, most physicians in small practices would need outside help to reengineer their office processes.