Study: EHRs and CDS don't improve care

A new study by a Stanford University Research team, published in the Archives of Internal Medicine, has found that current usage of 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 coauthored by Randall S. Stafford, MD, PhD, 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.

The pair's findings could be seen as a splash of cold water for the healthcare IT industry – and the federal government intent on spurring widespread EHR adoption with billions in financial incentives.

Even supplemented with clinical decision support (CDS), the study finds, EHRs were not associated with any significant gains in care improvement.

While certain past studies "within specific institutions have demonstrated better quality as a result of EHR implementation," they write, other research, taking a more general  view has "found no quality difference between ambulatory care provided with and without EHRs. Several recent studies have also failed to observe an association between EHR use and improved quality of care."

The question, then, was whether the addition of CDS might help lead to better results.

"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," write 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."

Indeed, they wrote, "several anecdotal articles describe how CDS can disrupt care and decrease care quality; however, further empirical research is needed."

It's important to note that the time period for the study preceded the 2009 passage of the 2009 HITECH act, which provided billions of dollars to help drive adoption.

[For a closer look at those numbers, see: HITECH Act 'lit a fire' under health systems.]

Stafford and Romano do note that the adoption of healthcare IT in this country is still in its infancy – a fact that may have contributed to their findings. And it's possible, they indicate, that ARRA stimulus and its subsequent meaningful use standards, could lead to different results in any similar studies in coming years.

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