Study: EHRs improve quality of care

Routine use of EHRs may improve the quality of care provided in community-based primary care practices more than other common strategies intended to raise the quality of medical care, according to study findings published Oct. 6 in the Annals of Internal Medicine.

According to the authors, recent proposals to reform primary care have encouraged physician practices to adopt such structural capabilities as performance feedback and EHRs. However, they noted that whether practices with these capabilities have higher performance on measures of primary care quality is “unknown.”

Data on practice structural capabilities were linked to multipayor performance data on 13 Healthcare Effectiveness Data and Information Set (HEDIS) process measures in four clinical areas: screening, diabetes, depression and overuse.

Mark W. Friedberg, MD, from the nonprofit organization RAND Corporation, studied 305 groups of primary care physicians in Massachusetts in 2007, finding that practices that used multifunctional EHRs were more likely to deliver better care for diabetes and provide certain health screenings with higher performance on five HEDIS measures (three in screening and two in diabetes), compared with those practices that did not, with statistically significant differences in performance ranging from 3.1 to 7.6 percentage points.

Also, the researchers found that frequent meetings to discuss quality were associated with higher performance on three measures of diabetes care (differences ranging from 2.3 to 3.1 percentage points). Meanwhile, physician awareness of patient experience ratings was associated with higher performance on screening for breast cancer and cervical cancer (1.9 and 2.2 percentage points, respectively).

While quality differences discovered in the study were “modest,” the authors said that the study is one of the first to demonstrate a link between use of EHRs in community-based medical practices and higher quality care.

"Overall, we were surprised by how few strategies to improve the quality of care were linked to measurably better performance," said Friedberg, an associate natural scientist at RAND. "The strategy that showed the most impact was use of advanced EHRs."

EHR systems were linked to higher quality care when the systems included advanced functions such as electronic reminders to physicians, and if the systems were used routinely by a medical practice.

The researchers said their findings are relevant to ongoing discussions about the potential benefits of broadly adopting EHRs across the nation's healthcare system. Recent federal legislation has called for new incentives for physicians who make "meaningful use" of the technology.

"EHRs with advanced features are uncommon nationally," Friedberg said. "Our results suggest that increasing their adoption may help improve the quality of care in important areas of preventive care and chronic disease management."