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Electronic records do not improve patient care, study finds

Electronic health records do not improve health care quality, even when accompanied with decision-making software, according to a recent Stanford study.

In research published Jan. 24 in Archives of Internal Medicine, researchers found that outpatient clinics and doctors’ offices using electronic health records from 2005 to 2007 performed better on only one of 20 quality indicators. Furthermore, doctors with “clinical decision software” performed better on only one indicator compared to doctors whose software gave no diagnosis tips.

The study, authored by Max Romano ’09 and professor of medicine Randall Stafford, compared physician survey data on patient visits in nonfederal offices and hospitals from 2005 to 2007. The researchers then examined the relationship between electronic records, decision software and the quality of care provided, using a set of 20 quality indicators developed by Stafford in a 2005 study.

The front of Stanford Med School. A recent Stanford study reports that electronic health records do not improve patient care. (KOR VANG/The Stanford Daily)

The research, which formed the basis of Romano’s senior honors thesis in Human Biology, found that physicians using electronic records performed better in one indicator–providing diet counseling to at-risk adults–compared with physicians not using electronic records. Also, the use of electronic records with decision software led to improved performance in one indicator–lack of routine electrocardiogram ordering–compared to doctors without software capability.

The findings echo those of a 2007 study, also published in Archives, that showed that electronic health records alone do not improve patient care. Romano was aware of the study but hypothesized that the availability of decision-making software might affect outcomes.

“We thought maybe there were too many types of electronic health records and that we should look at technology with advanced functions,” Romano said.

The study reports no consistent association between electronic records, decision software and better quality.” The findings come on the heels of the federal government’s allocation of $20 billion in 2009 to promote the use of electronic health records. Romano says the results may prompt multiple interpretations.

“You could interpret the results in two ways,” Romano said. “One conclusion is that, in order to make electronic health records work, we have to put more money [into their implementation]. The opposite conclusion is that maybe they’re not all they’re cracked up to be.”

According to the study, electronic records were used in about 30 percent of outpatient visits, while clinical decision software was used in about 17 percent of visits.

Romano views the move from paper to electronic records as an “inevitability” and suggests the results reflect this transitioning period.

“In any industry, when a new technology comes out, there’s a period of diversity in the marketplace before standardization,” Romano said. The electronic-records technology has not been around “long enough to allow standardization.”

He believes, however, that electronic health records have tremendous potential to improve care.

“One of the real benefits of electronic health records is the [systems’] ability to communicate with each other,” Romano said. “Most Americans see multiple health care providers, and our health care system isn’t set up to allow for communication between them…we can use electronic health records to improve comprehensive care.”

Contact Samantha McGirr at [email protected]

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