EHR Effectiveness for Hospital Care Questioned

A large RAND study of nearly half the acute care hospitals in the U.S. calls into question the value of electronic medical records, saying that except for basic systems used to treat congestive heart failure patients, EHRs are not improving process of care measures for many large hospitals that have them.

"The lurking question has been whether we are examining the right measures to truly test the effectiveness of health information technology," says Spencer S. Jones, a RAND scientist and lead author for the report. "Our existing tools are probably not the ones we need going forward to adequately track the nation's investment in health information technology."

Jones and authors write that their "results should temper expectations for the pace and magnitude of the effects of the Health Information Technology for Economic and Clinical Health (HITECH) legislation. The challenges and unintended consequences of EHR adoption are well documented."

Federal aid amounting to $30 billion is stimulating a national push to adopt EHR in healthcare settings, but Jones' report says that data demonstrating that the technology improves quality comes from a few large teaching hospitals and may not be representative of hospitals at large.

The study looks at 17 process measures for three common illnesses, heart failure, heart attack, and pneumonia between 2003 and 2007. Also, the number of hospitals using basic or advanced EHR grew from 24% to nearly 38% during that period.

Those 17 process measures included whether clinicians gave aspirin to patients who arrived in the hospital with an acute myocardial infarction, an ACE inhibitor or ARB for left ventricular systolic dysfunction to patients with heart failure and an oxygenation assessment to patients admitted with pneumonia. The measures did not include any outcomes.

Quality of care at all hospitals improved overall regardless of whether they had EHR over this time, but with the exception of patients with CHF, it did not improve faster at hospitals with EHR than at hospitals without it.