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Surveys Question EHR Value

By January 7, 2010Commentary

Researchers surveyed physician practices about their experience with EHRs in regard to care coordination.   (Abstract) The focus was on small to medium size groups using commercially available EHRs.  All the practices had to have been using their EHR for at least two years and most had the system in place for longer than that.  The physician groups were utilizing a wide variety of vendors to supply the EHR.  Care coordination was defined as activities related to ensuring continuity of care over time and across clinical settings, including collection and sharing of relevant information.  In general, the physicians did not report that the EHRs improved care coordination.  Interoperability was a major problem as was the time and effort required to learn about and use the system.  Many practices developed manual workarounds or supplements to the EHR.  There was a perception that documentation and data availability improved, but that data overload was also created, making patient management more difficult.  Most importantly, the systems were not widely viewed as improving information sharing across clinical settings and systems.

At the same time, the American Academy of Family Practitioners released a survey it conducted of physicians regarding EHR use.    (AAFP Survey) This survey asked physicians about the specific EHR systems their offices were using. Among other things, this survey provides an interesting look at at least some market perceptions of specific vendors.  The respondents were from all sizes of practices.  Certain vendors tended to be used more by certain size practices, for example, very large practices tended to use Cerner, Epic and GE more often.  The respondents were asked to rank their EHR on several dimensions.  Smaller practices tended to be more satisfied with and find more value in their systems, potentially because they had less complex needs.   Many practices don’t believe EHRs pay for themselves.  As with the research discussed above, data exchange with other systems was noted as a problem area.

A strong caveat for both these pieces of research is that they are surveys, so the results largely reflect the perspective of the respondents, not an objective assessment such as would be found in a randomized trial.  In the case of the second study, however, perception may be reality, in that if physicians are either happy or not happy with various aspects of a system, that probably directly leads to their perception of value.  In the context of the Administration’s push to incent adoption of EHRs and eventually punish their nonuse, issues about how much value is really created from their use are highly relevant.  The value of EHR that is constantly referenced by proponents is better quality care and lower costs stemming from that better quality.   At this point research does not necessarily show that that value is being created by current EHRs.

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