The use of electronic health records and clinical decision support tools does not significantly improve the quality of care in ambulatory patient visits, according to a report in the journal Archives of Internal Medicine, Health Data Management reports.
For the study -- titled, "Electronic Health Records and Clinical Decision Support: Impact on National Ambulatory Care Quality" -- Stanford University researchers assessed data from 255,402 outpatient visits in non-federal treatment facilities from 2005 to 2007. Researchers examined the relationship between the use of health IT tools and adherence to guideline-based treatment (Goedert, Health Data Management, 1/24).
The report found that EHR-supported patient visits contributed to a significant improvement in only one of 20 quality of care indices, compared with visits tracked using paper-based records. The one index was the frequency of providing diet counseling for high-risk adults, which occurred in 28.2% of visits in EHR-equipped practices, compared with 19.7% of visits involving paper records.
Researchers also found that adding clinical decision support to EHRs did not significantly increase the quality of care. The only indicator that fared significantly better with clinical decision support software was the indicator not to order electrocardiography tests for low-risk patients, which were avoided in 97.7% of cases in practices using clinical decision support, compared with 93% in practices without that capability (Gever, MedPage Today, 1/24).
Randall Stafford -- senior author of the study and associate professor of medicine at Stanford University -- said one reason EHRs were not associated with quality improvements is that physicians might require more training to benefit from such systems (Ostrow, Bloomberg, 1/24).
Stafford said, "These are complicated systems used by individuals who have received little formal training, at least until recently" (Conn, Modern Healthcare, 1/25).
The study authors added that data from 2005 to 2007 "may not reflect current practice patterns."
In an Archives of Internal Medicine commentary responding to the study, two NIH researchers raised concerns with the report.
They said the EHR and clinical decision support technology studied in the report could be "immature" compared with current systems. They added that EHRs without clinical decision support software should not be expected to improve adherence to medication guidelines because they are foremost "data repositories," rather than "prods to action" (MedPage Today, 1/24).