Electronic health records and clinical decision support don’t necessarily improve care

January 01, 0001

Electronic health records and clinical decision support don’t necessarily improve care

Electronic health records (EHRs) are increasingly used by US outpatient physicians. They could improve clinical care via clinical decision support (CDS) and electronic guideline-based reminders and alerts. Using nationally representative data, these US authors tested the hypothesis that a higher quality of care would be associated with EHRs and CDS. They analyzed physician survey data on 255,402 ambulatory patient visits in nonfederal offices and hospitals from the 2005-2007 National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey. Based on 20 previously developed quality indicators, they assessed the relationship of EHRs and CDS to the provision of guideline-concordant care.

They found: "Electronic health records were used in 30% of an estimated 1.1 billion annual US patient visits. Clinical decision support was present in 57% of these EHR visits (17% of all visits). The use of EHRs and CDS was more likely in the West and in multiphysician settings than in solo practices. In only 1 of 20 indicators was quality greater in EHR visits than in non-EHR visits (diet counseling in high-risk adults, adjusted odds ratio, 1.65). Among the EHR visits, only 1 of 20 quality indicators showed significantly better performance in visits with CDS compared with EHR visits without CDS (lack of routine electrocardiographic ordering in low-risk patients, adjusted odds ratio, 2.88). There were no other significant quality differences."

The authors concluded: "Our findings indicate no consistent association between EHRs and CDS and better quality. These results raise concerns about the ability of health information technology to fundamentally alter outpatient care quality."

It will take more than electronic records and reminder systems to change the delivery of guide-concordant care.

For the full abstract, click here.

Arch Intern Med 171(10):897-903, 23 May 2011
© 2011 to the American Medical Association
Electronic Health Records and Clinical Decision Support Systems-Impact on National Ambulatory Care Quality. Max J. Romano, Randall S. Stafford. Correspondence to Max Romano: [email protected]

Category: HSR. Health Services Research. Keywords: electronic health record, clinical decision support, reminders, alerts, cross-sectional national survey, journal watch.
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 7 June 2011

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.