PALO ALTO, CA – A new study by a Stanford University research team, published in the Archives of Internal Medicine, has found that using EHR and clinical decision support technology may improve administrative efficiency but does "not appear to translate into better outpatient quality of care."
The three-year study, titled “Electronic Health Records and Clinical Decision Support Systems: Impact on National Ambulatory Care Quality,” was co-authored by Randall S. Stafford, MD, and Max J. Romano, who examined data from more than 250,000 ambulatory visits between 2005 and 2007.
EHRs were in use for roughly 30 percent of those visits, with clinical decision support used for about 17 percent of them.
Even supplemented with clinical decision support, the study finds, EHRs were not associated with any significant gains in care improvement.
"Clinical decision support is an often-cited EHR mechanism of quality improvement, yet this study failed to detect significant improvements in healthcare quality among all U.S. practices using CDS systems," wrote Stafford and Romano. "While our findings do not rule out the possibility that the use of CDS may improve quality in some settings, they cast doubt on the argument that the use of EHRs is a ‘magic bullet’ for healthcare quality improvement, as some advocates imply."
Matthew Murray, MD, of the Brown Lupton Health Center at Texas Christian University, isn’t surprised by the study’s findings.
“There is more value to be gained by studies that analyze the impact of EHR selection and implementation factors that are known to result in successful implementations and uses of EHR technology, such as use of work flow analysis/redesign, performing and acting on needs assessments and identification of EHR requirements prior to selecting and implementing,” he said.
Patrick Casey, a consultant with PJ Casey Consulting, uses the analogy of the Panama Canal when talking about migration to EHRs and CDS. He prefaces his statement by saying that he recognizes that the move to this technology is both “inevitable and needed.”
Casey said U.S. President Theodore Roosevelt and advocates of the Panama Canal “were so focused on the grand benefits to be realized that they were practically obsessed in a rush ‘to make the dirt fly’ as soon as possible.”
“It wasn’t until the urgent project nearly failed, at great expense and even loss of life, that the new project manager took a step back and realized the whole endeavor had to be rethought, retooled and approached from a completely different angle. Only then did they succeed in creating the 20th Century’s first great technological miracle,” said Casey.
“Applying only what they had learned before would not suffice. They had to gain an appreciation for the truly unique challenge that this project presented, and match their techniques and solutions accordingly,” he said.
“I believe the current rush to create a nationwide medical information exchange system is perilously similar right now to the ‘make the dirt fly’ stage,” added Casey.
