Electronic Medical Records May Not Improve Quality of Care: Study

Published November 1, 2007

Electronic medical records (EMRs) have been touted as a major advancement in health care technology since their inception early this decade. Yet a Stanford University School of Medicine study released this summer shows the quality of health care depends much more strongly on human factors.

Lead author Randall Stafford, M.D., Ph.D., an associate professor of medicine at the Stanford Prevention Research Center, wrote that overall, in the 17 quality indicator areas studied, physicians using EMR had mediocre performance.

Stafford and his colleagues had expected better quality from doctors using an electronic record-keeping system that is being praised for its effectiveness and efficiency.

No Panacea

Though the study doesn’t discount EMR’s value, Stafford points out the entire health care system needs to embrace the concept of improving the quality of care delivered in clinic and office visits.

“We need to be cautious about the assumption that electronic health records are going to solve problems around health-care quality by themselves,” Stafford wrote. “It’s not sufficient to have an electronic health record system that provides readily available patient data and decision-making guidance. Physicians have to be receptive to that input and willing to act on that input.”

No Significant Difference

According to the report, on 14 of the 17 quality indicators EMRs made “no significant difference” in patient care. The indicators included such factors as prescribing recommended antibiotics; diet and exercise counseling for high-risk adults; screening tests; and avoiding potentially inappropriate prescriptions for elderly patients.

“I don’t think the study is a surprise,” said Twila Brase, president of the Citizens’ Council on Health Care, a group based in Minnesota. “What the study shows and what others have found is that EMRs force physicians into sort of a box, and it forces the attention of the physician to the computer screen or to accessing the data according to the electronic format, rather than walking into a patient’s room and talking to them.

“I think EMRs can be a detriment to a patient’s health care,” Brase continued. “One example came to light not long ago at a health care institution in California. Their entire computerized system crashed for several days, so they had to try to figure out how to start doing things on paper again. If you are dependent on electronic data systems, you find out the problems when the system crashes and you have nothing.”

Data Improvements

Don Schoen, CEO of MediNotes Corporation, a worldwide provider of EMRs based in West Des Moines, Iowa, said the Stanford report is dated. In the three years since the data on which it is based were released, EMR technology has changed significantly, offering physicians and staff ease of use, he said.

Nonetheless, Schoen warns no EMR system will work without proper training and implementation.

“Getting the right processes in place is key, whether it be our products or other products in the industry, in that you really have to have all of the elements in place–proper processes, implementation, training, and support,” said Schoen. “Patient care gets improved inherently when you have all of the pieces of information in front of you.”

EMRs’ advantages far outweigh their disadvantages, Schoen said.

“The doctors that utilize our product in the right way can see up to $40,000 more a year in their practice, just from having a more efficient system,” said Schoen. “But that’s just the beginning. Instead of seven minutes of busywork, trying to pull the chart, trying to read each other’s handwriting, trying to flip through the pages to figure out what’s gone on with the patient before, … you get five minutes of true, quality care.”

Reliability Concerns

Brase said the issue isn’t the technology itself, but care providers becoming too dependent upon it.

“There is an unwise trust in electronic data that should not be there,” Brase said. “Just because it’s all printed out neatly and electronically doesn’t necessarily mean that it’s the truth.”

Judi E. Loomis ([email protected]) writes from Indiana.

For more information …

“Electronic Health Record Use and the Quality of Ambulatory Care in the United States,” by Randall Stafford et al., Archives of Internal Medicine, July 9, 2007: http://archinte.ama-assn.org/cgi/content/short/167/13/1400