No really, how bad are electronic health records? We know they cause problems and nobody likes using them. They’re billing platforms that the healthcare industry has tried to twist and pull into all-in-one care management tools. Adoption was slow, accelerated by government mandates over the past decade. To put it simply, the healthcare industry and EHRs have a deep, necessary, and sometimes contentious relationship.
Because of all the bad press, it’s worth taking a step back to evaluate EHRs for what they really are today and what they could do in the future. That is the premise of a recent review in Annual Reviews of Public Health titled “The Digitization of Patient Care: A Review of the Effects of Electronic Health Records on Health Care Quality and Utilization.”
Here are a few key points covered in the review. Leave your thoughts in the comments below:
EHRs’ role in improving quality of care is getting clearer
Most data from the first 15 years of research (1995-2010) indicated that EHRs didn’t improve quality of care, or at least that a direct relationship could be drawn between EHRs and outcomes. In the past 12 years, though, the data looks far more promising. Over half (56-62%) of studies “yielded unambiguously positive consequences from EHR systems,” with another 30% showing generally positive results.
Where EHRs have shown significant value is in managing medication. This includes reducing medication errors, making better decisions about drug dosages, and limiting drug-drug interactions. Thus, clinical decision support and communications tools within EHRs are particularly useful.
EHRs do save lives
Studies have found that EHRs reduce deaths, but usually only when looking at high-acuity or complex patients. For “average” cases, there’s not much evidence of a link between EHR use and mortality. Research into patient safety has yielded vague results in the past, although newer work has shown “larger” improvements in patient safety.
We still don’t have solid national data on EHRs
The authors note that most studies only look at a single healthcare organization, so extending findings to a national scale is tricky. In particular, there’s a link between an organization’s bent towards innovation and the care delivered to patient: “Early EHR adopters often provided higher-quality care than did providers who opted not to adopt EHRs.” This is an interesting point highlighting the differences in corporate mindset that exist. We anticipate that similar links will show up in the future with other areas of innovation. Forward-thinking providers who are always looking for new ways to serve patients are by their very nature doing a better job caring for those patients than providers who are resisting change.
EHRs may save us all money
In an ideal world, EHRs could save the US healthcare system more than $80 billion each year, according to one study cited in the review. But… we don’t live in an ideal world. Instead, administrative tasks that could in theory but aren’t in reality being handled by EHRs cut into that savings. In addition, the cost of implementing and running an EHR can limit the savings or even increase costs. Interestingly, the authors note that providers in “geographical areas that are more IT-industry intensive” have better results in this regard. Variability between individual provider organizations makes it hard to draw broad conclusions about the direct financial implications of EHRs.
However, when researchers have taken indirect factors like operational efficiency, productivity and net patient revenue into account, the value of EHRs starts looking a little bit better.