The expanded government spending to encourage more rapid adoption of electronic medical records has also spurred more research to identify whether the use of such a system actually has a positive impact on quality of care and health outcomes, and whether their use lowers either administrative or medical costs. A new study by Rand Corporation researchers published in the American Journal of Managed Care provides further illumination on the subject. (AJMC Article)
The researchers looked at a large percent of all US hospitals and categorized them as no EMR, basic EMR and advanced EMR. It then looked to see if changing status was associated with better quality scores for heart attack, heart failure and pneumonia treatment. Adoption of a basic EMR was associated with better quality improvement for heart failure, but not the other conditions. Adoption of an advanced EMR was associated with significant decreases in quality improvement for heart attack and heart failure. It may be that “advanced” systems are simply too complex and make it harder for medical professionals to do a good job.
The authors expressed concern that the generally high levels of performance by most hospitals on existing quality measures means that it will be difficult to demonstrate a positive effect from EMR adoption or upgrade and that perhaps new measures are needed. This sounds like saying we have to come up with some measure that shows EMR are good for quality improvement. It might be, however, and indeed appears to be the case, that quality improvement can occur just fine without an EMR, so maybe the focus on justifying EMRs needs to be cost, although the evidence is skimpy there too. Or maybe, our government once again is just spending billions of dollars on something that really isn’t going to make much difference.