EHR Alone May Have Limited Ability to Improve Care Quality

The implementation of electronic health record (EHR) systems have little effect on measures such as patient mortality, surgical complications, length of stay, and costs, according to a new study.

Researchers at Massachusetts General Hospital (MGH; Boston, USA) and the Harvard School of Public Health (HSPH; Boston, MA, USA) analyzed data collected in a 2008 survey sent to the chief operating officers (COOs) of acute care hospitals belonging to the U.S. American Hospital Association; completed surveys were returned from almost 3,000 hospitals across the United States. Respondents were asked whether and to what extent their institutions had implemented computerized systems for 32 functions--including medication orders, lab reports, specimen tracking, and discharge summaries. Also included in the analysis was general information about the hospitals and the populations they serve; standard measurements of quality related to the care of heart attack, congestive heart failure and pneumonia; and measures of efficiency from the 2006 Medicare Provider Analysis and Review File.

The results were compared among hospitals with comprehensive EHR systems (defined as having 24 functions available in all clinical units), institutions with basic systems (10 functions in at least on major unit), and those with none. The researchers found that although a few functions were associated with modest improvements--in areas such as length of stay and surgical infection prevention--the differences were small and none was broadly associated with significant levels of improvement. The study was published in the April 2010 issue of Health Affairs.

"We are still in the early days of electronic health record adoption, and there's little evidence for how best to implement the technology to make the greatest gains,” said lead author Catherine DesRoches, Ph.D., of the MGH. "Hospitals may not see the benefit of these systems until they are fully implemented, or it may take many years for benefits to become apparent.”

"This study has important implications for the [U.S.] government's efforts to define 'meaningful use,' the federal standard for receiving financial incentives,” added senior author Ashish Jha, M.D., M.P.H, of the HSPH. "Ensuring that hospitals use these systems in a robust way will be critical to obtaining value from the large investment that the nation is making in health information technology.”

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Massachusetts General Hospital
Harvard School of Public Health