Our health system just underwent an upgrade from the 2009 version of an EHR to the 2012 version. The color scheme is a little different. The painfully cluttered workflow is not significantly changed. I’m sure there are many Very Important Features – likely relating to burdensome documentation regulations – but, from a clinical standpoint, it still feels like we’re working with Windows 3.1.
But, we suffer this hacked together kludge because of the promise for tangible improvements in quality of care. One area that has markedly changed with the advent of EHR is the ability to obtain significant medical histories on our patients – without the need to rely on the imperfect patient interview. The hope of these authors was that, if they compared patients for whom they had complete records established in the EHR to patient who were EHR naive at their facility, they’d be able to demonstrate improvements in at leasts surrogate markers for patient-oriented outcomes.
Looking retrospectively at three EDs covering 13,227 patient visits, these authors found essentially statistical noise. Comparing multiple outcomes including hospitalization, ED LOS, quantity lab orders, and hospital mortality, they found inconsistently distributed variation that is more likely attributed to unmeasured confounders than any element of the EHR itself.
Like most folks using EHRs, I suspect there are small, difficult-to-measure improvements in healthcare delivery. Interoperability and centralized data sources would contribute vastly, I hope, to reduced testing and admission rates without adverse effects on outcomes. However, we’re still waiting for proof.
“The impact of electronic health records on people with diabetes in three different emergency departments”
http://www.ncbi.nlm.nih.gov/pubmed/23842938