Friday, August 29, 2014
Have We Finally Confirmed That EHRs Do Actually Make A Positive Difference?
This appeared a little while ago.
Posted on Jul 28, 2014
By Jack Beaudoin, Special Contributor
Health Data Miner
For at least the last decade, the health IT field has seen a scholarly back-and-forth on the effectiveness of electronic medical records. As soon as one study is published that finds technology has little impact on patient outcomes, another emerges that seems to show just the opposite.
These studies are frequently limited by the size of the data set or scope of the analysis. Take, for example, a June 2014 JAMA article that found meaningful users of electronic health records failed to deliver improved care for five chronic diseases. According to one news report, the new study cast “doubt on whether the tens of billions of dollars invested to encourage EHR adoption among healthcare providers is really enhancing patient outcomes.”
The analysis, it turns out, included just three months of data from 818 physicians (about .1 percent of the 834,769 active physicians practicing in the United States) across seven clinical quality measures. By the way, all those physicians were employed by a single hospital or its affiliated practices.
And the variable being studied? It distinguished physicians who qualified for MU1 against those who did not. Considering the low bar set by MU1, the distinction might not signify all that much.
So what if, instead, you had a data set that drew from ALL the hospitals in the United States. And what if that data ranked healthcare IT adoption not on MU1, but on a multi-tiered scale, from no technology use to completely paperless systems? And what if the outcomes studies included 19 patient cohorts in five service lines, from heart failure and pneumonia to sepsis and stroke, with findings adjusted for risk and other differences in patient health status?
That study might be a little more authoritative when it comes to evaluating "whether the tens of billions of dollars invested to encourage EHR adoption among healthcare providers is really enhancing patient outcomes."
And the good news is, that study now exists and it has found that EMRs do have a measurable, positive impact on care as measured by clinical outcomes of risk-adjusted mortality rates.
One example is mortality from heart attacks. The mortality rate at high EMRAM facilities (9 percent) is half that of heart attack mortality at low EMRAM facilities (18 percent).
The details of this study will need to be closely followed - especially as it is a study with evidence accumulated from real world use of EHRs. I look forward to further publications on this study to confirm validity.
Posted by Dr David More MB PhD FACHI at Friday, August 29, 2014