The nation is plunging headlong into an era of expanded electronic medical records implementation and use. The benefits are said to be lower administrative and health costs and better quality. We have posted before on the lack of clear research support for these benefits and on the dreadful experience many physicians and hospitals have had in implementing EMRs. New research to be published in Health Services Research also suggests caution. (ASU Research)
The researchers are business school professors who assumed that EMR’s would have benefits and sought to quantify those by examining the experience of 300 community hospitals in California over ten years. What they found was that, at least in the short term, costs went up and some areas of quality suffered. Administrative costs increased, not just in the IT department, but also in nurse staffing, contrary to expectations that efficiency would lead to need for less nurses. Complications increased and hospital stays were up, although the researchers note the former may be due to better reporting with EHRs. And higher stays could be due to hospitalizations being limited to sicker patients. But it is also possible the EHRs cause distraction, less focus and don’t improve and may worsen care processes.
Mortality was lower, primarily due to fewer medication errors, and the researchers were optimistic that in the long run EMRs will have benefits. The research is simply not yet supportive of this. The increased IT costs alone make it unlikely administrative costs decrease. While quality should be improved, as the researchers point out, more IT doesn’t by itself improve already bad processes. The focus needs to be on how the IT can help change processes to improve outcomes. EMRs are coming no matter what and probably are the right thing to do, but we all need to be realistic about the costs and the hassle involved in implementing and using them.