Typical Electronic Health Record Use in Primary Care Practices and the Quality of Diabetes Care: don't count your chickens

From the Annals of Family Medicine May/June 2012:

In this longitudinal observational study of primary care practices, we found that practices using an EHR for a 3-year period had a poorer quality of diabetes care at baseline, did not make more rapid quality improvements than practices using paper records, and had a poorer quality of diabetes care at the 2-year follow-up.  via www.annfammed.org

 

Count me among those hardly shocked. 

Many who advocate the expanded use of health IT appear to believe that health IT itself will catalyze improvements in care. While there may be a few narrow instances where this is the case, we believe that most current health IT systems have a long way to go before they encompass the functionality that would support robust ongoing improvement of care. Additionally, the success of health IT-enabled improvement depends critically on the skills of clinical and administrative staff in primary care settings to understand and use solid improvement methods—methods that need not rely solely on health IT to be effective. (Langley 2007)

 

Too many of the improvement plans I come across rely heavily on the oft-touted benefits of health information technologies.  "We'll use our electronic health record to find gaps in care and this will improve our chronic care outcomes."  or  "With electronic health records we will reduce duplication of services and unnecessary testing and reduce costs."

Maybe.

But the results to date are not as encouraging as some marketing materials would lead one to believe. 

In this controlled study, EMR use led to an increased number of HbA1c and LDL tests but not to better metabolic control. If EMRs are to fulfill their promise as care improvement tools, improved implementation strategies and more sophisticated clinical decision support may be needed. (O'Connor 2005)

 

As you consider interventions to improve outcomes for individuals and populations, consider carefully the strategies you will use to change work flow, who is doing what, and the very nature of the work being done.  To achieve meaningful results we must change the way we work, not merely create an electronic version of the way we have always worked.

There are some good strategies that truly support overstretched and under-resourced primary care practices and their patients, but too many intitiatives just pile on demands, drawing clinicians further away from the people who need their time. (Bodenheimer 2008)

 

L Gordon Moore

Bodenheimer T.  "Transforming Practice" N Engl J Med 2008; 359:2086-2089

Langley J, Beasley C. Health Information Technology for Improving Quality of Care in Primary Care Settings. Prepared by the Institute for Healthcare Improvement for the National Opinion Research Center under contract No. 290-04-0016. AHRQ Publication No. 07-0079-EF. Rockville, MD: Agency for Healthcare Research and Quality. July 2007.

O’Connor PJ. “Impact of an Electronic Medical Record on Diabetes Quality of Care,” The Annals of Family Medicine 3, no. 4 (July 1, 2005): 300–306.

Comments

[L Gordon Moore]

Mcorn310 I could not agree more.

What you describe is one of the visions of good electronic systems - seamless and secure communicate between clinicians and people/patients.

This feature is not available in most current electronic health records and even when available is not used.

I wish that it were.

[Mcorn310]

I think EMR is a significant step up in the medical industry. I actually have to use a physical therapy billing software with my trainer and I think it is outstanding. I am able to check to see when my next payment is due, look at my medical history, and even look at the kinds of therapy I received. I only see it as a convenience.