HealthAffairs: For improved costs and quality, EHRs alone may not be enough

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The implementation of EHR systems may not be enough to significantly improve health quality and reduce costs, according to a study in the April issue of Health Affairs. Researchers from the Mongan Institute for Health Policy at Massachusetts General Hospital in Boston reported finding that currently implemented systems have little effect on measures such as patient mortality, surgical complications, length of stay and costs.

The authors noted that greater attention may need to be paid to how systems are being implemented and used, with the goal of identifying best practices.

"We are still in the early days of EHR adoption, and there's little evidence for how best to implement the technology to make the greatest gains," said lead author Catherine DesRoches, DrPh, of the Mongan Institute. "Hospitals may not see the benefit of these systems until they are fully implemented, or it may take many years for benefits to become apparent."

The study, in which researchers analyzed data collected in a 2008 survey sent to the chief operator officer of acute-care hospitals belonging to the American Hospital Association, sought to examine the effects of electronic systems in a nationally representative group of hospitals. According to the authors, while several earlier studies suggested that specific aspects of an EHR – particularly computerized physician order entry – could improve the quality and efficiency of care, those studies analyzed data from hospitals with customized systems and dedicated quality improvement staff.

Completed surveys were returned from almost 3,000 hospitals in the 50 states and District of Columbia. Respondents were asked whether and to what extent their institutions had implemented computerized systems for 32 functions, including medication orders, lab reports, specimen tracking and discharge summaries.

Also included in the analysis was general information about the hospitals and the populations they serve; standard measurements of quality related to the care of heart attack, congestive heart failure and pneumonia, as reported in the 2009 Hospital Quality Alliance database; and measures of efficiency from the 2006 Medicare Provider Analysis and Review File.

Results for hospitals with comprehensive EHR systems – defined as having 24 functions available in all clinical units – were compared with those of institutions with basic systems – 10 functions in at least one major unit – and those with none. Although a few functions were associated with modest improvements in areas like length of stay and surgical infection prevention, the differences were small and none were broadly associated with significant levels of improvement, the study found.

"Our findings suggest that hospitals need to pay special attention to how they implement these systems. Simply having the technology available is probably not going to be enough," wrote DesRoches, also an assistant professor of medicine at Harvard Medical School. "Hospitals will need to effectively integrate new systems into their current practices. Studying institutions that have been successful will provide important lessons for everyone."

"This study has important implications for the government's efforts to define 'meaningful use,' the federal standard for receiving financial incentives," said the study's senior author Ashish K. Jha, MD, of the Harvard School of Public Health. "Ensuring that hospitals use these systems in a robust way will be critical to obtaining value from the large investment that the nation is making in health IT."