JAMIA: Study of EHRs' impact is inconclusive
Researchers investigating the effects of EHRs on healthcare outcomes at three Minneapolis area emergency departments (ED) expected the presence of documentation available in EHRs to have a measurable positive effect on clinical decision-making, but the results of their study failed to make a conclusive determination.
“While our investigation has revealed a number of positive associations between EHR availability and improved hospital-related outcomes and ED resource use, causality cannot be definitively established with the study design we used,” Donald P. Connelly, MD, from the University of Minnesota, and colleagues wrote.
With results published Nov. 14 in the Journal of the American Medical Informatics Association, the researchers conducted a retrospective study that examined quality and efficiency measures for 5,166 adult patients who presented to one of three EDs with congestive heart failure (CHF). Patients were listed as internal if their information was present in the EHR system, and as external if not.
At two of the EDs, internal patients had lower odds of mortality if hospitalized, fewer laboratory tests performed and fewer medications prescribed. At one of those two EDs, internal patients were less likely to be hospitalized. At the third ED, internal patients were more likely to experience longer lengths-of-stay than external patients.
The authors acknowledged that many ED physicians had anticipated longer ED visits for patients with EHR information available, but also raised the possibility that variations between the locations or patient groups could account for the negative outcome at the third ED.
“Because the clinical impact of IT is dependent on the services deployed and many other local contextual issues, it is not surprising that results varied among the three EDs, each housed in a different health delivery system,” the authors wrote.
“The differences in care and outcome between the two patient groups could be a product of fundamental difference[s] between the two patient groups not accounted for in this study rather than their experience in the ED and, for some, the hospital,” they added.
Despite the study’s mixed and inconclusive results, researchers remained optimistic that EHRs could have a positive economic effect by reducing the amount of hospital resources spent on each patient.
“Because the odds for hospitalization and in-hospital mortality were reduced and some reductions in resource use for patients with CHF were seen, the potential economic impact may be substantial for a nation that expended nearly $40 billion on CHF healthcare in 2007,” the authors wrote.
The authors concluded by suggesting that more definitive studies of EHRs’ impact should be conducted in the future.
“While our investigation has revealed a number of positive associations between EHR availability and improved hospital-related outcomes and ED resource use, causality cannot be definitively established with the study design we used,” Donald P. Connelly, MD, from the University of Minnesota, and colleagues wrote.
With results published Nov. 14 in the Journal of the American Medical Informatics Association, the researchers conducted a retrospective study that examined quality and efficiency measures for 5,166 adult patients who presented to one of three EDs with congestive heart failure (CHF). Patients were listed as internal if their information was present in the EHR system, and as external if not.
At two of the EDs, internal patients had lower odds of mortality if hospitalized, fewer laboratory tests performed and fewer medications prescribed. At one of those two EDs, internal patients were less likely to be hospitalized. At the third ED, internal patients were more likely to experience longer lengths-of-stay than external patients.
The authors acknowledged that many ED physicians had anticipated longer ED visits for patients with EHR information available, but also raised the possibility that variations between the locations or patient groups could account for the negative outcome at the third ED.
“Because the clinical impact of IT is dependent on the services deployed and many other local contextual issues, it is not surprising that results varied among the three EDs, each housed in a different health delivery system,” the authors wrote.
“The differences in care and outcome between the two patient groups could be a product of fundamental difference[s] between the two patient groups not accounted for in this study rather than their experience in the ED and, for some, the hospital,” they added.
Despite the study’s mixed and inconclusive results, researchers remained optimistic that EHRs could have a positive economic effect by reducing the amount of hospital resources spent on each patient.
“Because the odds for hospitalization and in-hospital mortality were reduced and some reductions in resource use for patients with CHF were seen, the potential economic impact may be substantial for a nation that expended nearly $40 billion on CHF healthcare in 2007,” the authors wrote.
The authors concluded by suggesting that more definitive studies of EHRs’ impact should be conducted in the future.