Study: EHR usage not always linked to better hospital care
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The study, which included 2,021 hospitals, or about half the nonfederal acute care hospitals across the U.S., spanned 2003 to 2007.
Researchers found that hospitals with basic EHRs demonstrated a significant increase in the quality of care for patients being treated for heart failure. However, similar gains were not noted among hospitals that upgraded to advanced EHRs, and hospitals with EHRs did not have higher quality care among patients treated for heart attack or pneumonia.
The findings are part of a growing body of evidence suggesting that new methods should be developed to measure the impact of health IT on the quality of hospital care.
"The lurking question has been whether we are examining the right measures to truly test the effectiveness of health IT," said the study's lead author Spencer S. Jones, an information scientist at RAND. "Our existing tools are probably not the ones we need going forward to adequately track the nation's investment in health IT."
Use of EHRs is growing rapidly among U.S. hospitals, spurred by a major federal investment in the technology. Legislation approved in 2009 may eventually provide as much as $30 billion in federal aid to hospitals that invest in EHRs.
One expected benefit of EHRs is improved quality of care. But most of the current knowledge about the relationship between health IT and quality comes from a few hospitals that may not be representative of most U.S. hospitals, such as large teaching hospitals or hospitals that were among the first to adopt EHRs.
The RAND study is one of the first to look at a broad set of hospitals to examine the impact that adopting EHRs has had on the quality of care. Researchers determined whether each hospital had EHRs and then examined performance across 17 measures of quality for three common illnesses: heart failure, heart attack and pneumonia.
The number of hospitals using either a basic or advanced EHR system rose sharply during the period studied, from 24 percent in 2003 to nearly 38 percent in 2006.
Researchers found that the quality of care provided for the three illnesses generally improved among all types of hospitals studied from 2004 to 2007. The largest increase in quality was seen among patients treated for heart failure at hospitals that maintained basic EHRs throughout the study period.
However, quality scores improved no faster at hospitals that had newly adopted basic EHR technology than in hospitals that did not adopt the technology.
In addition, at hospitals with newly adopted advanced EHRs, quality scores for heart attack and heart failure improved significantly less than at hospitals that did not have EHRs; and EHRs had no impact on the quality of care for patients treated for pneumonia.
The mixed results may be attributable to the complex nature of healthcare, researchers said. Focusing attention on adopting adverse drug interaction may divert staff from focusing on other quality improvement efforts. In addition, performance on existing hospital quality measures may be reaching a ceiling where further improvements in quality are unlikely.
New performance measures that focus on areas where EHRs are expected to improve care should be developed and tested, according to researchers. For example, EHRs are expected to lower the risk of adverse drug interactions, but existing quality measures do not examine the issue.
Support for the study was provided by RAND COMPARE (Comprehensive Assessment of Reform Efforts), which is funded by a consortium of individuals, corporations, corporate foundations, private foundations and health system stakeholders.