Electronic health records have been hailed as a key element in making U.S. medical care more effective and efficient, but a new study led by a researcher at the Stanford University School of Medicine shows that electronic records were not associated with improved quality of outpatient health care in 2003 and 2004.
Of 17 quality indicators assessed by the study, electronic health records made no difference in 14 measures. In two areas, better quality was associated with electronic records, while worse quality was found in one area.
Senior author Randall Stafford, MD, PhD, associate professor of medicine at the Stanford Prevention Research Center, said that given the overall mediocre performance of physicians in the 17 quality indicator areas, he and his colleagues had expected better quality from doctors using electronic records.
Stafford said the study doesn't discount the value of electronic health records, but points out that 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 said. "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."
The study, produced by a team of researchers from the Stanford and Harvard medical schools, will be published in the July 9 issue of the Archives of Internal Medicine.
The 14 quality indicators for which electronic records made no significant difference 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.
In two quality areas - not prescribing benzodiazepine tranquilizers for patients with depression, and avoiding routine urinalysis during general medical exams - doctors using electronic record systems fared better than those who didn't. But when it came to prescribing statins for patients with high cholesterol, physicians using electronic systems did worse.
Electronic health record systems have become a centerpiece in the quest to improve the quality of health care. By storing a patient's medical history in electronic form, such systems can eliminate errors due to bad handwriting, make it easier to follow patient information over time and enable physicians to easily share patients' records. Additionally, the more sophisticated systems can flag potential problems, such as mixing medications that might trigger a bad reaction, and provide advice about which tests to order or which medications to prescribe.
Past studies have assessed the use of electronic health records in hospitals, where patients are acutely ill and quality issues can have life-threatening consequences. But relatively little research has examined the performance of electronic health records in outpatient settings, Stafford said. However, much of today's health care is delivered during visits to clinics or doctors' offices, so it's important to know whether the electronic systems are producing better outcomes, he added.
For the study, Stafford and his colleagues drew their data from the National Ambulatory Medical Care Survey, a survey conducted by the National Center of Health Statistics that provides information on patient visits to office-based physician practices.