Adopting an electronic health record (EHR) doesn't necessarily lead to better management of patient populations, according to research published in the June 4 issue of the Annals of Internal Medicine.
While the U.S. Centers for Medicare and Medicaid Services (CMS) provides incentive payments to physicians who use an EHR to evaluate patient care, only 10% of physicians surveyed reported being able to use their EHR systems to meet the meaningful use criteria.
Of the 1,820 primary care physicians and specialists in office-based practices surveyed in late 2011 and early 2012, 43% reported having a basic EHR. Less than one-half of these respondents reported the presence of computerized systems for any of the patient population management tasks included in the team's survey, however (Ann Intern Med, June 4, 2013, Vol. 158:11, pp. 791-799).
"Results support the growing evidence that using the basic data input capabilities of an EHR does not translate into the greater opportunity that these technologies promise," wrote lead author Dr. Catherine DesRoches, of Mathematica Policy Research in Cambridge, MA, and colleagues.
Using EHRs as simple replacements for paper records will not result in the gains in quality and efficiency or the reductions in cost that EHRs have the potential to achieve, according to the authors.
"On the other hand, when physicians and others can use and take advantage of the full scope of the EHR's functionalities, they may be more likely to improve the quality, efficiency, and patient-centeredness of the care they deliver," they wrote.
An unintended outcome
The study shows that the U.S. government's intention to improve healthcare quality and reduce cost instead seems to have stimulated sales and implementation of systems that don't work very well, wrote Ross Koppel, PhD, from the University of Pennsylvania, in an accompanying editorial in the same issue (pp. 845-846).
"Healthcare providers struggle with EHRs that are information silos largely incapable of communicating with each other," Koppel wrote. "Data are in such varied formats and structures that information transfer would be almost impossible, even with rational communication protocols. Far more systems, with more bells and whistles but with the same severe limitations, are on order."
Although laudable, the U.S. Office of the National Coordinator for Health Information Technology's recent interoperability rules ask for too little, too late, Koppel said.
While the current policy places faith in market processes, incremental changes, and regulatory hints to achieve data standards, interoperability, and usability, the study's findings demonstrate that such faith is chimerical, according to Koppel.
"The necessity to improve care and reduce costs is too compelling to allow the current chaos to continue," Koppel concluded. "This study shows that if EHRs are to fulfill their promise, we must shift from cheering health information technology implementations to demanding health information technology utility."
