January 25, 2011

Do Electronic Health Records Really Help?

One of the White House's key methods to improve healthcare in the United States -- electronic health records -- may actually do little or nothing to improve quality, researchers said on Monday.

A team from Stanford University in California analyzed data from nationwide surveys of more than 250,000 doctor's office visits and other outpatient settings between 2005 and 2007.

The team found that electronic health records did very little to improve quality, even when there was "decision support" software that gives doctors tips on ways of handling individual patients.

"Across a wide range of quality indicators there was no consistent association between having those electronic tools available and providing better quality of care," Dr. Randall Stafford of Stanford, whose study appears in the Archives of Internal Medicine, told Reuters.

However, electronic health records systems that include this software have been shown in other studies to greatly improve quality of health.

President Barack Obama has put information technology at the heart of ways to cut costs out of the US healthcare system, offering some $27 billion in government funds to speed up the process of going all electronic.

The push is based mostly on the assumption that electronic records will improve communication and reduce medical errors. But that may not be so.

In a previous study, Stafford's team showed that simply putting paper records into a digital format did little to improve healthcare. In the new study, the same team looked at whether adding decision support tools helped.

Those tools are meant to remind doctors of guidelines for treating specific conditions. For example, they might remind a doctor to order a specific test, or specific medication.

But the team found the tools didn't significantly improve quality of care, said Stafford. The study suggests that improving health quality will take more than just adding information technology to the mix.

"We need to be more realistic about what to expect from electronic health records," Stafford said in a telephone interview with the global news agency.

"I believe this study suggests that it is naive to believe that the simple presence of an electronic health record or even these systems with more advanced functionality will by themselves change the quality of care," he said.

Drs. Clement McDonald and Swapna Abhyankar of the National Institutes of Health said in a commentary in the same journal that Stafford's findings were "dismal."

They said other studies have found well-employed decision support programs have been shown to improve care. They added that the systems analyzed in Stafford's study were immature, and better training would improve the outcome.

Stafford said stimulus funding to standardize medical records may improve what he said is now a patchwork of systems.


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