EHRs and Quality

Researchers examined whether there were links between a physician practice’s “structural capabilities” and performance on HEDIS quality measures.  (Annals Article) (Registration required for full article)  Structural capabilities include patient assistance and reminders; electronic health records with various functionality; a culture of quality; and enhanced access, such as interpreters and weekend hours.  The HEDIS measures included screenings, diabetes treatment, depression treatment and avoidance of overuse.

The researchers surveyed a large percentage of all Massachusetts physician practices on their structural capabilities and then compared that information with the practices’ performance on the HEDIS measures.  Overall, structural capabilities had little correlation with HEDIS performance.  The most notable effect was that use of multifunction electronic health records improved performance on some screening measures and some aspects of diabetes care.  Interestingly, practice size, network affiliations and multispecialty status were not associated with performance on any of the HEDIS measures.

One possibility, which the HEDIS performance data supports to some extent, is that most Massachusetts physicians were and are doing a good job of delivering appropriate care, at least as measured by HEDIS.  The improvement related to EHRs may be caused by better reporting through electronic systems, not any real change in care delivery, although to the extent the physicians have pay-for-performance linked to HEDIS, they should be incented to report regardless of use of EHRs.  This study indicates that improving quality is likely to be more complex than just changing structural capabilities of physician practices.