AIM: Ambulatory EHR+CDS may not lead to better care
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“These results raise concerns about the ability of health IT to fundamentally alter outpatient care quality,” wrote Max J. Romano, BA, and Randall S. Stafford, MD, PhD, from Stanford University in Stanford, Calif.
The authors analyzed physician survey data on 255,402 ambulatory patient visits in nonfederal offices and hospitals from the 2005 to 2007 National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey.
Based on 20 previously developed quality indicators, Romano and Stafford assessed the relationship of EHRs and CDS to the provision of guideline-concordant care using multivariable logistic regression. They found that EHRs were used in 30 percent of an estimated 1.1 billion annual U.S. patient visits. CDS was present in 57 percent of these EHR visits, or 17 percent of all visits.
The use of EHRs and CDS was more likely in the West and in multiphysician settings than in solo practices, according to the authors. “In only one of 20 indicators was quality greater in EHR visits than in non-EHR visits (diet counseling in high-risk adults),” they wrote.
In addition, “only 1 of 20 quality indicators showed significantly better performance in visits with CDS compared with EHR visits without CDS (lack of routine electrocardiographic ordering in low-risk patients). There were no other significant quality differences,” Romano and Stafford stated.
“In a nationally representative survey of physician visits, neither EHRs nor CDS was associated with ambulatory care quality, which was suboptimal for many indicators,” the authors commented. “We noted no association between EHR use and care quality for 19 indicators and a positive relationship for only one indicator.
“We also found CDS use associated with better quality for only 1 of 20 quality indicators, refuting our hypothesis that CDS would be associated with improved care quality. Some studies suggest that certain guidelines and clinical areas lend themselves well to CDS intervention, while others do not. However, the lack of association between EHR and CDS and care quality in our study fails to support such conclusions,” they noted.