EHRs not fulfilling promise of improved healthcare delivery

Despite their growing use, electronic health records (EHRs) are not yet fulfilling their potential for improving the nation's healthcare system. To do that, the EHRs and the people who use them will have to improve in the areas of health information exchange, clinical decision support, and using EHR data for learning.

Read: EHRs: Five ways to put data into action

That is among the conclusions of a recent progress report on EHR adoption and use issued jointly by the Robert Wood Johnson Foundation, Mathematica Policy Research, the Harvard School of Public Health and the University of Michigan’s School of Information.

While noting that EHR adoption among hospitals and physicians has grown significantly in recent years, the report’s authors add, “more recent evidence suggests that current approaches to EHR use are not generating real value for the health care system. This raises the critically important question: What else do we need to do … to produce real, near-term performance improvement in the delivery of healthcare?”

The first step, they say, is to improve clinicians’ ability to exchange patient health information with one another. “Physicians are hamstrung in their ability to make good clinical decisions when they lack the critical information about care that might have occurred in other settings,” the authors note. “And coordinating care for expensive and complex patients is particularly difficult when their information is trapped in EHRs in different settings where they receive care.”

Read: ONC unveils proposal for health IT interoperability

Next: Doctors must demand patient healthcare data

Efforts to improve information exchange are hampered by concerns over privacy and security, the report says, and by the tendency among some physicians and healthcare institutions to view the availability of patient data as a competitive tool, so that data-sharing decisions are driven by strategic considerations, rather than what benefits the patient.

Most important, doctors themselves have to demand patient health data and use it when it is available. “Physicians are accustomed to making clinical decisions with incomplete information, and the notion that they would be responsible for reviewing patient data from all past clinical encounters is daunting,” the authors say.

When it comes to clinical decision support (CDS), EHRs have been fairly robust in incorporating medication safety, but they lag in their ability to promote evidence-based care. For example, whereas 81% of hospitals in an American Hospital Association health information technology survey had drug-allergy and drug-drug interaction alerts in their EHR systems, only 55% had implemented clinical guidelines in all clinical units.

Read: Excessive EHR alerts can lead to information overload

This gap presents an opportunity to use EHR-based CDS to promote adherence to evidence-based care, the authors say. But doing so will require EHR vendors to develop CDS modules that are more flexible and easily updatable than the tools currently available.

Finally, EHRs can help improve the healthcare system by providing doctors with reliable, timely data they can use to assess performance and identify opportunities for improvement.These opportunities are especially important, the authors say, for managing care for high-cost, complex patients, and becomes even more powerful “when individuals, teams, or even entire organizations experiment with new approaches to care delivery and use real-time measures to assess the impact.”