Electronic health records alone don’t improve care in heart failure

By itself, use of electronic health records (EHRs) does not improve the quality of care for heart failure, says Mary Norine Walsh, MD.

In a national study, outpatient cardiology practices that used EHRs performed no better on six of seven care measures than those that did not use EHRs.

Seven quality-of-care measures were compared between 87 sites that used electronic health records (50 used them exclusively, 37 used a combination of electronic and paper records) and 80 sites that used paper records only. The seven measures were all evidence-based guideline-recommended practices:

• Use of ACE inhibitors or angiotensin-receptor blockers

• Use of beta blockers

• Use of aldosterone-receptor blockers

• Use of anticoagulation therapy in patients with atrial fibrillation

• Use of implantable cardioverter-defibrillators

• Use of cardiac resynchronization therapy

• Provision of heart failure education

Only the use of aldosterone-receptor blockers in appropriate patients and the provision of heart failure education were significantly more common among the sites that used EHRs compared with the sites that did not. When adjusted for practice characteristics, only the provision of heart failure education remained significantly better among the sites that adopted electronic records.

“These observations are consistent with a recent 2008 Health Information Technology in the United States [study] that found no significant association between electronic health record use and quality of care,” says Dr. Walsh, a cardiologist and director of nuclear cardiology and congestive heart failure at St. Vincent Hospital in Indianapolis. Performance improvement interventions may also be needed in addition to electronic records to influence quality of care and clinical outcomes, she adds.