EHRs On Trial … Again
By Ken Congdon, editor in chief, Health IT Outcomes
New research published in the March issue of Health Affairs and covered in a March 5 article in the New York Times once again calls into question the ultimate value of EHRs. In most health IT circles, digital patient records have been touted as a key way to reduce the number of medical tests ordered, thereby cutting healthcare costs. However, this new study suggests that EHRs might actually encourage doctors to order these expensive tests more often. In fact, the research shows that physicians with computerized access to a patient’s previous image results ordered tests on 18% of visits, while those without tracking technology ordered tests on 12.9% of visits — that’s a 40% higher rate of image testing by doctors using EHRs instead of paper records.
As expected, this study is concerning to many in the healthcare industry, but now comes the point in the article where I punch holes in this new research. My biggest criticism of this study is the research pool itself. This research was based on a survey conducted by the National Center for Health Statistics, which collected data from more than 28,000 patient visits to more than 1,100 doctors in … get this … 2008. That’s right, 2008. That’s before ARRA (The American Recovery and Reinvestment Act) outlined a stimulus program for EHR adoption and long before Meaningful Use requirements provided a roadmap for EHR implementation and functionality. In my opinion, this is kind of like doing a study on the effectiveness of air travel using the Wright Brothers’ first few planes as the sample for the research. The vast majority of EHRs in use in 2008 bared little resemblance to the EHRs the federal government is motivating healthcare institutions to deploy today.
Furthermore, few EHRs in 2008 incorporated many of the key features and functionalities — namely clinical decision support — that will ultimately be instrumental in ensuring excessive medical testing is held in check. The researchers themselves even admitted that any kind of computerized access to patient records or images was included in the study, no matter how old or isolated the function. In other words, the computer application didn’t even have to be an EHR by definition, and didn’t have to be integrated with other systems. When the research pool of this study is taken into consideration, I believe the results are much less concerning. Now, I won’t go on record saying that EHRs will definitely save the healthcare industry $80 billion a year, as has been suggested by RAND Corporation. However, I’m still a proponent of EHR technology, and believe strongly that EHRs, when implemented in line with Meaningful Use standards, will help limit excessive tests and reduce healthcare costs.
This Just In! Doctors Actually Like Health IT
Not all the news released over the past few days has condemned EHRs. To the contrary, a report released March 6 by CDW Healthcare illustrates the positive impact EHRs are having on the healthcare community. This report, based on a survey of 200 IT professionals and 200 caregivers at large hospitals, addressed a wide variety of health IT solutions, but EHRs were definitely a primary focus. The study showed that 56% of those surveyed have deployed or were deploying an EHR in the past 18 months and 32% have deployed or were deploying HIE (health information exchange) within the same timeframe. More compelling, however, is the fact that 84% of the caregivers (doctors and nurses) surveyed said that EHRs and other health IT solutions are helping to improve patient care overall. This admission was surprising to me because doctors and nurses have historically been the most vocal opponents to moving to EHRs because of the negative impact the technology often has on their workflows. However, in this survey, 85% of doctors and nurses said that EHRs provided them with better availability of information, 72% said the technology allowed them to provide more accurate care to patients, 68% said EHRs helped to track and improve follow up care, and 40% also said health IT allows them to spend more time with patients.
This CDW research is promising because it targets large hospitals — the segment of the healthcare market that is probably the furthest along in terms of EHR adoption and Meaningful Use. If these facilities are beginning to realize these benefits, then it’s likely that these benefits will trickle down to small/midsize community hospitals and ambulatory care centers as EHR adoption and implementation continues to evolve in these facilities.