Blumenthal feature: Health IT improves outcomes, patient satisfaction is next
 | |
| David Blumenthal, MD, MPP, national coordinator for health information technology |
However, dissatisfaction with EHRs among some providers remains a barrier to achieving their full potential, wrote authors Melinda Beeuwkes Buntin, director of the Office of the National Coordinator for Health IT's (ONC) Office of Economic Analysis, Evaluation and Modeling; Matthew F. Burke, ONC policy analyst; Michael C. Hoaglin, former ONC policy analyst; and David Blumenthal, MD, the U.S. National Coordinator for Health IT.
Provider satisfaction "is clearly an area that needs work and we are trying to address that both through enhancing the market—making it possible for new entrants to come into the market—and also by working to develop better tests of usability of EHRs, which we’re doing with the National Institutes of Standards and Technology,” Blumenthal said in an interview.
The review included 154 studies conducted between July 2007 and February 2010, tracking 278 individual outcome measures. Sixty-two percent of the studies were deemed positive, meaning that health IT was associated with improvement in one or more aspects of care and no detriment to other aspects; and 92 percent were either positive or mixed-positive. Mixed-positive articles or outcomes were those in which the authors drew a positive conclusion overall but the article demonstrated at least one negative aspect of health IT use.
Of the 278 measures tracked, 86 percent had at least mixed-positive outcomes.
Sixty-nine of the included studies assessed EHRs, 44 addressed computerized provider order entry (CPOE) and 44 assessed clinical decision support (CDS) systems. Categories were not mutually exclusive.
Ten studies contained negative overall findings, and represent potential problems associated with the implementation and use of health IT, the authors wrote. For example, one negative article, which evaluated e-prescribing at three ambulatory care sites, found e-prescribing took marginally longer than handwritten prescriptions. However, the article did not evaluate the accuracy of prescription orders from the electronic application versus those from a paper-based system.
In another example, the reviewers cited a descriptive study evaluating the implementation of health IT in a small rural hospital. "According to the authors’ assessments, the hospital faced a lack of clinical leadership, staff skepticism, leadership turnover, an unrealistic schedule and a vendor whose products were not ready on time. The implementation was associated with an increase in patient care errors, including medication errors, procedure errors, and patient falls. Had the IT system been better planned and implemented, the [study] authors believe that these pitfalls could have been avoided."
A large majority of the recent studies show measurable benefits emerging from the adoption of health IT. However, “with so few negative articles and findings, there is only suggestive evidence that more advanced systems or specific health IT components facilitate greater benefits,” they stated.
“This review is as close to a clearly positive statement about a technology as you’re likely to get in a complex, empirical field,” Blumenthal said. “There are positive studies, there are negative studies, and there are some that are more positive than negative. It’s the balance of the sources of information that you have to examine.
"We are developing momentum, and the momentum will accelerate. We announced today that we now have 50,000 providers enrolled in our Regional Extension Centers. Almost 34,000 providers signed up to become meaningful users. This shows that the field is moving and once it goes in that direction, there will be no turning back."