Electronic Health Records With Technical Assistance Can Improve Patient Care In New York City
Sustained EHR technical assistance is vital to boost quality of care by small physician practices
The relationship between a physician practice's adoption of electronic health records (EHR) and quality improvements in patient care remains unclear. However, a new study published in the January issue of Health Affairs by
To evaluate the effects EHRs have on patient care within small physician practices, the research team used an independent data source using multi-payer medical claims in
The research study found EHR implementation alone was not enough to improve patient care overall or known "EHR sensitive" quality improvement measures, such as cancer screenings and diabetes care. In fact, the researchers reported it took physician practices a minimum of nine months of EHR exposure, combined with eight or more technical assistance visits, to demonstrate any significant statistical improvements in certain key quality measures, including breast cancer screening, retinal exam and urine testing for diabetes patients, chlamydia screening for women and colorectal cancer screening. Physician offices with minimal or no technical support did not show any significant improvements, even when these practices had been using EHRs for up to two years.
"EHRs were once thought to be a cure-all for helping improve patient care, but there are implementation issues and the technology has a steep learning curve," says lead author Dr. Andrew M. Ryan, assistant professor of public health at
"These study findings are consistent with observations from our field staff that small physician practices serving the disadvantaged areas of
Researchers say it will be important to continue to evaluate the effectiveness of various levels of technical support provided by regional extension centers in improving health outcomes.
EHRs supply physicians with clinical decision support, tools to reduce medical errors, e-prescribing, test result displays, patient health registry information, population data management and improved communication with patients and other providers. The rate of EHR adoption for outpatient care is rising. Physician use of basic EHR systems has increased from 22 percent in 2009 to 35 percent in 2011. But small practices, which constitute the majority of practices in the
"EHRs hold a lot of hope and promise and the technology is taking health care a step in the right direction. Our study supports proof of concept that EHRs can improve outcomes, but widespread implementation of the technology and strong technical assistance is needed," says Dr. Ryan. "Our hope is the extension of EHRs with proper technical support will have a direct impact on population health."
The study findings are consistent with other research showing that EHRs alone do not consistently improve quality of care. This is one of the few studies to have evaluated the effect of EHRs implementation on the quality of care in a community outpatient setting focusing on physicians in small practices who serve primarily disadvantaged patients.
"Our study results stand in contrast to widespread perceptions that EHRs automatically improve quality of care. It shows that regional extension centers like NYC REACH have an important role to play in facilitating the use of EHRs to improve the quality of care patients receive -- which is always our ultimate goal," says the study's senior author Dr. Lawrence P. Casalino, the Livingston Farrand Associate Professor of Public Health and chief of the Division of Outcomes and Effectiveness Research at Weill Cornell. In addition, Dr. Tara F. Bishop, assistant professor of public health and medicine at Weill Cornell, is a co-author of the study.
This research was funded by the Robert Wood Johnson Foundation and performed in close collaboration with the New York City Department of Health and Mental Hygiene, who shared data from its Primary Care Information Project.
About Weill Cornell Medical College
Weill Cornell Medical College, Cornell University's medical school located in New York City, is committed to excellence in research, teaching, patient care and the advancement of the art and science of medicine, locally, nationally and globally. Physicians and scientists of Weill Cornell Medical College are engaged in cutting-edge research from bench to bedside, aimed at unlocking mysteries of the human body in health and sickness and toward developing new treatments and prevention strategies. In its commitment to global health and education, Weill Cornell has a strong presence in places such as Qatar, Tanzania, Haiti, Brazil, Austria and Turkey. Through the historic Weill Cornell Medical College in Qatar, the Medical College is the first in the U.S. to offer its M.D. degree overseas. Weill Cornell is the birthplace of many medical advances -- including the development of the Pap test for cervical cancer, the synthesis of penicillin, the first successful embryo-biopsy pregnancy and birth in the U.S., the first clinical trial of gene therapy for Parkinson's disease, and most recently, the world's first successful use of deep brain stimulation to treat a minimally conscious brain-injured patient. Weill Cornell Medical College is affiliated with NewYork-Presbyterian Hospital, where its faculty provides comprehensive patient care at NewYork-Presbyterian Hospital/Weill Cornell Medical Center. The Medical College is also affiliated with the Methodist Hospital in Houston. For more information, visit weill.cornell.edu.
Source: Weill Cornell Medical College