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EHR Effectiveness for Hospital Care Questioned

Cheryl Clark, for HealthLeaders Media, December 29, 2010

"Adoption of advanced EHR capabilities was associated with significant decreases in quality improvement for acute myocardial infarction and heart failure," the authors write.

RAND used Health Information Management Systems Society survey data, which includes 90% of U.S. hospitals and includes clinical IT application implementation status, excluding hospitals that didn't disclose their software vendor. Hospital process measures were taken from Medicare's Hospital Compare.

The authors segmented hospitals by their level of EHR adaptation:

 No EHR indicates the lack of 1 or more of the following: clinical data
repository, electronic patient record, and clinical decision support
systems.

 Basic EHR indicates the full complement of an operational clinical data repository, electronic patient record, and clinical decision support systems.

 Advanced EHR indicates all the components of a basic EHR plus operational computerized provider order entry.

The authors acknowledge six significant limitations in their study. First, they could not quantify the impacts EHR might have on conditions other than these three. Second, they could not measure how extensively hospital teams used their systems nor could it account for significant variation in the different types of systems used. 

Third, the hospitals for which they had data may not be transferrable to all hospitals n the country. And fourth, they suggest that for some conditions such as AMI and pneumonia, there may be points over which improvement is difficult to achieve. 

"These ceiling effects may explain why we observed a significant decrease in the rate of quality improvement for AMI and no significant change in the rate of quality improvement for pneumonia in hospitals that adopted the new EHR capabilities," they write.

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