A survey in the "Archives of Internal Medicine" by Stanford researchers is stirring debate on the benefits of electronic health record applications.
Researchers
at Stanford University
in California have released a
report saying that electronic health records may not improve patient care, even
if they include a feature called clinical decision support. CDS is a software
function that provides alerts or reminders to doctors on how to care for
patients.
Dr.
Randall S. Stafford, associate professor of medicine at the Stanford
Prevention Research
Center in California,
and Max J. Romano, a former Stanford undergraduate and now Johns Hopkins
medical student, conducted the study. The results were published
online
on Jan. 24 by "Archives of Internal Medicine," an American Medical
Association journal.
Electronic
records were only helpful when providing diet consultations, according to the
Stanford study, and CDS usage improved care only to avoid unnecessary
electrocardiograms during routine examinations, the study found.
Researchers
compiled data from more than 250,000 patient visits to health care facilities
between 2005 and 2007. Of an estimated 1.1 billion annual U.S.
patient visits, EHRs were used in 30 percent of these visits, while software
provided CDS support in 57 percent of these cases in which EHRs were used,
according to the Stanford report.
"Across
a wide range of quality indicators, there was no consistent association between
having those electronic tools available and providing better quality of
care," Stafford told
Reuters.
"We
need to be more realistic about what to expect from electronic health
records," Stafford added. "I believe this
study suggests that it is naive to believe that the simple presence of an
electronic health record or even these systems with more advanced functionality
will by themselves change the quality of care," he said.
The
study may have had some holes, however, according to industry experts,
particularly because of the aging data.
"Regardless
of the study's validity, the strong reaction to the study is due in part to the
fact that since the study concluded nearly four years ago, the technology
driving clinical decision support has grown significantly more sophisticated,
with the ability to deliver highly personalized alerts specific to a patient's
unique medical history to the point of care," Rich Noffsinger, CEO
of
Anvita Health, wrote in an e-mail
to eWEEK.
Anvita's
Insight CDS engine culls clinical data from EHRs and lab results. Insight also
provides alerts in subsecond time in the event of adverse events such as drug
reactions.
Meanwhile,
two National Institutes of Health researchers
wrote
that the EHR and CDS applications used for the Stanford study were
"immature" and that the survey used incomplete patient data.
"The
results
that Romano and Stafford found were dismal," Dr.
Clement McDonald and Dr. Swapna Abhyankar wrote in another "Archives of
Internal Medicine"
piece.
"The
investigators
observed no consistent difference in guideline
adherence among
providers who used paper medical records compared
with those
who used either an EHR alone or an EHR with
CDS."
Although
the results of the study have some validity as far as EHR and CDS products in
the past, they don't show the potential of future EHR implementations,
according to Shahid Shah, CEO of IT consulting
firm Netspective Communications and author of the
Healthcare IT Guy blog.
"The
numbers they've come up with are reasonable interpretations of the raw numbers
available in the NAMCS [National Ambulatory Medical Care Survey]," Shah
wrote in an e-mail to eWEEK.
"However, the important thing to realize is that the study results
aren't tied to specific EHR implementations and didn't discuss the usability of
EHR systems-even with slight improvements in CDS usability and algorithms you
can see decent outcomes," he said. "So the study is valid in the data
analysis, but the data analyzed doesn't have enough attributes nor nuance to be
able to use it for predictions about future systems."
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