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Care quality is not necessarily better with electronic health records

Electronic health records (EHR) do not automatically guarantee higher quality care in medical settings, a new study finds. Researchers from Harvard and Stanford looked at the effect EHRs had on 17 indicators of quality, including disease management, antibiotic use, preventive counseling, screening tests, and drugs prescribed for elderly patients. They found EHRs improved performance for 2 indicators, worsened performance for 1, and offered no real advantage for the remaining 14.

Physicians using EHRs scored well in not prescribing sedatives (benzodiazepines) to depressed patients and avoiding routine urinalyses at general medical visits. In addition, when researchers limited the study sample to primary care and heart physicians, those who employed EHRs more often counseled smokers to quit. Yet, doctors who had EHR systems didn't do as good a job in prescribing medication for patients with high cholesterol as those who didn't use EHR systems, notes Jeffrey A. Linder, M.D., M.P.H.

Dr. Linder and colleagues used 2003 to 2004 data from more than 50,000 patient records collected by the National Ambulatory Medical Care Survey of patient visits to U.S. physician practices. Electronic health records were used in 18 percent of about 1.8 million ambulatory medical visits during the study period.

The authors note that performance for both groups—with and without EHRs—was below par, indicating there is room for improvement across the board. They stress that no one should assume that quality improves as EHR use widens. Earlier studies conducted by the Agency for Healthcare Research and Quality, however, found that EHRs can boost the amount of care that meets with guidelines, improve care through clinical monitoring, and curtail medical errors.

The authors recommend that physicians adopting EHR systems consider ones that include clinical decision support and use that feature to improve care.

This study was funded in part by the Agency for Healthcare Research and Quality (HS14563 and HS11313).

See "Electronic health record use and the quality of ambulatory care in the United States," by Dr. Linder, Jun Ma, M.D., R.D., Ph.D., David W. Bates, M.D., M.Sc., and others, in the July 9, 2007, Archives of Internal Medicine; pp. 1400-1405.

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