Electronic Medical Records Not Associated with Better Ambulatory Care
As currently used, electronic medical records do not bring about improvements in ambulatory care, according to a study in Archives of Internal Medicine.
Using 17 quality indicators, researchers examined records of more than 50,000 ambulatory patient visits from 2003 and 2004. The data were collected as part of the National Medical Ambulatory Care Survey, which asked, "Does your practice use electronic medical records (not including billing records)?"
In multivariable analyses, use of electronic records was associated with improvement in only 1 of 17 indicators — avoiding urinalyses at general medical visits. One indicator, use of statins in hyperlipidemia, showed a worse result among practices using electronic records. The other 15 indicators showed no differences.
The authors write that "one should not assume an automatic diffusion of improved quality" as electronic medical records become more widely used. They recommend that practices adding electronic records "carefully consider the inclusion of clinical decision support."
1 comment:
There are many outstanding electronic medical record systems on the market, and many of these systems have the POTENTIAL to materially improve patient outcomes, but technology by itself cannot and will not fix everything. Transformational improvement in ambulatory quality of care requires transformational changes to the way ambulatory care physicians practice medicine. Said another way, the system needs to be fixed, and it's difficult to fix the system without a judicious application of information technology.
This is hard work, and unfortunately, the fruits of this labor are unfairly enjoyed - physicians must work hard to transform how their system is structured, and payers disproportionately reap the benefits. (That's not to say physicians don't reap any of the benefits!)
I've found that some physicians mislead themselves (or perhaps are misled by others) to believe that dramatic change is one switch flip away; that setting up an EMR system will fix everything. Many other physicians recognize such systems are one ingredient in a larger recipe for change, and some of these ingredients consist of "old fashioned" changes to how workflow is performed in the office. Of course, our payment system needs to change, too. To be sure, I've seen physicians dramatically improve their care (not to mention reduce costs and maximize time) by making the most of their software solution.
It has been my experience that the very best EMR is only as good as what the user does with it. Many systems will reinforce good care practices, and some will help physicians avoid practicing poor care, but a lot of users simply rely on the software to automate bad habits. It just so happens that ALL software systems can do this if the user wants it to. lol
Physician Advice: If a software vendor (or any type of vendor, for that matter) promises that their solution will single-handedly solve all your problems with little or no effort on your part, run in the other direction. I wish things were so simple. The right software with the right user can really make a difference, but it will not by itself solve all of your issues.
EMR Software Guy,
http://www.electronic-medical-record.blogspot.com
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