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Electronic health records no cure-all
January 24th, 2011
05:34 PM ET

Electronic health records no cure-all

Electronic medical records,  also known as EHRs, often touted as a powerful antidote for uncoordinated and ineffective medical care, do little to help patients outside the hospital, according to a new study.

Researchers from Stanford University analyzed federal data on more than 255,000 patients, about a third of whom had health information carried electronically. The researchers compared the care of those patients to the care of patients without EHRs, on 20 different measures of quality – for example, whether proper medication was prescribed for patients with asthma or simple infections, or whether smokers were counseled on ways to quit. On 19 of the 20 measures, there was no benefit from having an EHR. The one exception was dietary advice: Patients at high-risk for illness were slightly more likely to receive counseling on a proper diet.

The U.S. Department of Health and Human Services has pushed hard to encourage the adoption of electronic medical records, including $19 billion worth of incentives for doctors and hospitals. A move to EHRs is one of the less controversial aspects of health care reform, and the shift is often touted by President Obama.

But skeptics say there are serious risks to an overreliance on EHRs, from missing information to simple computer crashes. A report last month from the ECRI Institute, a respected organization that studies science and health issues, listed “data loss and system incompatibilities” as one of ten “Top 10 Health Technology Hazards for 2011.”

Jeffrey C. Lerner, president and chief executive officer of the ECRI Institute, said the new findings are no surprise. "It is reasonable to assume that electronic health records will ultimately help the cause," he told CNN in an email, "but new technology has a learning curve. Think of your smart phone. Improving quality will remain a tough challenge, but avoiding technology use doesn’t sound like an alternative.”

To examine whether better technology might help, the Stanford team also looked at whether care was better when physicians used a computer system to help guide them through treatment options. It barely made a difference.

The project was started by Max Romano, an undergraduate at the time who now studies medicine at Johns Hopkins University. The final paper was co-written with Dr. Randall Stafford, a professor at the Stanford Prevention Research Center.

"Our initial hope was that we would see a correlation between electronic health records and quality, and when we looked at the subset of patients whose doctors got help from the clinical decision support systems [decision-making software], we'd see an even stronger relationship," says Stafford.  "Perhaps we need to re-examine the naive assumption that just putting in place an EHR system will make a huge difference."

While praising federal efforts to standardize and streamline EHRs, Stafford said the findings raise serious questions about the scope and speed of the $19 billion campaign. "There is a need to question investing that much societal resource in electronic health records when we really don’t know the answer of what effects those are going to have,. Having made that decision, it's incumbent for us to demand exactly what we have gotten out of the investment."

 


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soundoff (95 Responses)
  1. rheumatologist

    re emr's: garbage in and you know what fallows. i routinely get the clinical equivalent of "war and peace" with the push-a -button instant clinical visit report from medical offices that have invested a good deal of time and money on certifiable emr's.
    it is almost impossible to know why they sent their patient for a consultation. this does nothing to foster good medicine. it truly is garbage.

    January 25, 2011 at 17:05 | Report abuse | Reply
    • cmon man

      If you are aware of patients who have been injured or killed when care was guided by EHR and/or CPOE, report it to the FDA at the MedWatch site on line.

      January 25, 2011 at 20:49 | Report abuse |
  2. cmon man

    It has been admitted by the FDA that these are medical devices, yet they are being sold without FDA approval.

    The studies that show any benefit have been paid for by the HIT vendors and promoted by trade groups EHRA, HIMSS, CCHIT and industry promoted thought leaders of CHIME. Did I leave out any of the industry promoters that have educated Congress to spend $ billions of taxpayers' dollars on meaningfully unusable medical devices?

    Is any one listening? Is anyone investigating this scandal?

    January 25, 2011 at 20:39 | Report abuse | Reply
  3. EHR expert

    As noted above, EHRs are "not ready for prime time." The billions spent by the feds implementing unsafe systems has been a waste and degraded the health system overall. The money should have been spent on research on development.

    January 26, 2011 at 10:44 | Report abuse | Reply
  4. Shea Steinberg

    Look at the results of paper record effectiveness and you will see that thousands of people die every year due to errors involving paper records- whether that be messy illegible handwriting or misplacement of a chart note. While the EMR impact is low at this point (10% adoption rate), the meaningful use incentives will push more doctors to make the digital switch which will overtime provide a much more secure environment for the patients information and provide a better workflow for doctors.

    Practice Fusion EMR: http://www.practicefusion.com

    January 26, 2011 at 19:58 | Report abuse | Reply
  5. razzlea

    http://razzlea.blogspot.com/

    January 27, 2011 at 10:00 | Report abuse | Reply
  6. Molly

    As someone who was in the EMR or EHR if you prefer business for 14 years, I can say with confidence the real problem is the poor quality of the actual EMR's. They are created by companies and engineers and product managers who don't know beans about how those who would use their product actually work. They don't know anything about medicine or nursing so their products are difficult to use and so unintuitive as to be counter productive. Maybe is someone as talented as those as Apple and also clinicians would create an EMR it might actually work. It isn't that EMR's don't work; it is the crap that is out there called EMR that is why they fail. Have yet to see one that would do what the promise of EMR's was said to be and not take forever for clinicians to input the data. I am also a former ICU/CCU nurse and must say that I would dread having to use these terrible systems.

    January 28, 2011 at 11:25 | Report abuse | Reply
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Get a behind-the-scenes look at the latest stories from CNN Chief Medical Correspondent, Dr. Sanjay Gupta, Senior Medical Correspondent Elizabeth Cohen and the CNN Medical Unit producers. They'll share news and views on health and medical trends - info that will help you take better care of yourself and the people you love.