More EHR Reality

For over two decades electronic patient, medical or health records have been put forth as one of the best ways to improve quality and lower costs.  This view was adopted in the stimulus bill, which provided a huge boost in federal funding to encourage adoption of these systems by physicians and hospitals.  A great variety of research, qualitative and quantitative suggests that the promise of these systems for both purposes has often been greatly exaggerated and potential problems ignored.   British researchers compiled a systematic review of electronic record studies in the latest Milbank Quarterly.  (Milbank Article)

The researchers looked both at other meta-reviews and at new primary research.  They systematically and at great length categorized and analyzed approaches to studying implementation and use experience.  Finally they compared the assumptions underlying the massive IT overhaul of the British health service with the reality uncovered by their review and suggested future areas needing further research implementation.  The United Kingdom effort was based on the belief (common to many American EMR projects) that, among other things, the system could be integrated seamlessly and easily into the clinical workflow and would increase the effectiveness of that work; would replace most paper records and would add more value the more broadly it was distributed.  The researcher found to the contrary that seamless integration of EMRs did not occur and were very unlikely to occur; that they might make “secondary” uses such as billing, audit and research more efficient, but not clinical work; that smaller local systems appear to almost always be better than large off-the shelf ones; and even that paper records had some unique advantages.

It would appear prudent before we further encourage use of EMRs or punish their non-use, to follow up on the research suggestions in this study, so that we might expend public money in the most beneficial manner.