MU gets low marks for improving care
Sure, the EHR Incentive Program – with its $22 billion paid out thus far to meaningful users – might have helped bring the healthcare sector out of the Dark Ages and into the 21st Century, but do these systems really improve the quality of patient care?
For the most part, a new study says, 'no'.
Researchers at Harvard Medical School and Brigham and Women's Hospital compared physician performance across seven Stage 1 quality measures for five chronic diseases between providers who demonstrated meaningful use of electronic health records and those who did not.
[See also: Study shows EHRs help docs boost care.]
The results were underwhelming. Following the data on nearly 860 physicians, 63 percent of which were considered meaningful users, out of the seven quality measures, meaningful use was associated with lower quality for two measures and "marginally better" quality for two measures. And for the remaining three, researchers found no association between meaningful use adopters and care quality.
Patients with hypertension and diabetes who needed LDL management and control and were treated by MU providers fared significantly better than similar patients who were treated by non-MU providers, according to the study. Some 44 percent of hypertension patients treated by docs who were meaningful users, for example, received high quality care, compared to 38 percent receiving high-quality care and being treated by non-MU docs.
Those faring the worst with providers who were also meaningful adopters of electronic health records were chronic asthma patients and those requiring long-term depression management. Some 59 percent of patients with chronic asthma had higher quality care with MU providers, compared to 66 percent with non-MU providers. For depression, the gap was more salient: 42 percent of patients seeing MU-adopting physicians had high quality care, compared to 68 percent treated by non-MU docs.
Many officials have noted that Stage 1 is just the beginning, aimed at first getting hospitals and doctors to adopt these systems, and Stage 2 adds clinical quality improvements. But Stage 3 is what many officials say will really pack the punch with regard to improving clinical outcomes.
Moreover, as a supplemental commentary to the study pointed out, Stage 2, which raises the thresholds of many of the quality measures, has just kicked off, and Stage 3 isn't set to go live until 2017.
[See also: Federal panel scales back MU Stage 3.]
"Thus, the full effects of MU on quality may not be measurable until Stages 2 or 3," said Lisa M. Kern, MD, of Weill Cornell Medical College, in the commentary.
"I think the focus of meaningful use Stage 3 shifting to outcomes is the right one," former ONC coordinator Farzad Mostashari, MD, said last fall, though he also acknowledged that Stage 3 is slated to be more demanding on physicians and hospitals relating to clinical quality measures and population health requirements.
This study contrasts another report released earlier this year that found that physicians who used electronic health records reported clinical benefits. This study, unlike the one conducted by Harvard researchers, focused on the perceptions of physicians.
"A majority of physicians said they were alerted to a potential medication error or critical lab value, and about one-third reported that EHRs helped them identify needed lab tests or facilitated direct communication with patients," said Jennifer King, chief of research and evaluation at the Office of the National Coordinator for Health Information Technology and lead author of the study, in a statement earlier this year.
Just this April, members of the Health IT Policy Committee gave the green light to a set of 19 Stage 3 measures, a 33 percent reduction in the original number of proposed measures.
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