Electronic health records use have only had a limited effect on improving medical care quality in US hospitals, scientists from the RAND Corporation wrote in the American Journal of Managed Care. Although adopting basic electronic health records resulted in considerable improvements in quality of care for heart failure patients, hospitals that upgraded to advanced health electronic records did not experience similar gains for pneumonia or heart attack treatments, the authors discovered.

The researchers believe that their findings, along with other recent ones in previous studies, suggest that novel methods need to be developed to gauge the impact of health information technology on hospital care quality.

Lead author, Spenser S. Jones, said:

    “The lurking question has been whether we are examining the right measures to truly test the effectiveness of health information technology. Our existing tools are probably not the ones we need going forward to adequately track the nation’s investment in health information technology.”

Spurred on by considerable federal investment, electronic health records use is expanding rapidly in American hospitals. As much as $30 billion in federal grants for electronic health records investment in hospitals have been brought about after legislation approved in 2009.

Experts, health care professionals and hospital managers and administrators had expected significant improvements in quality of care to be one of the benefits of electronic health records. However, current data on the relationship between health information technology and quality comes from a small number of hospitals which may not be representative, as large teaching hospitals would be, or the first hospitals to adopt EHR (electronic health records).

This study, the authors explained, involving 2,021 hospitals – approximately 50% of the non-federal acute care hospitals throughout the USA – is the first to examine a wide range of hospitals, and assess the impact EHR might have had on quality of care.

The investigators first determined whether a hospital had EHR, and then gathered data on its performance across 17 measures of quality for three illnesses – pneumonia, heart attack, and heart failure. They looked at data on each hospital from 2003 to 2007.

In 2003, twenty-four percent of hospitals had basic or advanced EHR. By 2006 the figure had risen to 38%.

Across all three illnesses, quality of care improved from 2004 to 2007 among all types of hospitals. The best improvement was seen in heart failure treatment in hospitals which maintained basic EHR for the whole period of study.

However, hospitals that adopted no EHR technology also experienced improvements which were not significantly different from those with basic EHR.

Of concern were the findings for hospitals which adopted advanced electronic health records, whose heart attack and heart failure treatment improvements were inferior to hospitals with no EHR at all. As for pneumonia treatment quality of care, EHR was found to have no impact.

Health care, with its complex nature, might need to be examined differently to find out the true impact of EHR, the authors wrote. Concentrating too much on adopting electronic health records may divert staff from striving in other areas. Some hospitals might have become as good as they could get before adopting EHR, as far as existing quality measures are concerned.

Existing quality measures do not examine what impact EHR might have on reducing the risk of adverse drug reactions. Perhaps new performance measures should include more areas, especially those where EHR is more likely to have measurable impact.

Jones said:

    “With the federal government making such a large investment in this technology, we need to develop a new set of quality measures that can be used to establish the impact of electronic health records on quality.”

“Electronic Health Record Adoption and Quality Improvement in US Hospitals”
Spencer S. Jones, PhD; John L. Adams, PhD; Eric C. Schneider, MD; Jeanne S. Ringel, PhD; and Elizabeth A. McGlynn, PhD
The American Journal of Managed Care 2010;16(12 Spec No.):SP64-SP71

Written by Christian Nordqvist