Evaluating the Benefits of EHRs

We have noted a number of times that the value of health information technology in producing actual improvement in health outcomes has likely been overhyped.  The latest review of a variety of electronic health capabilities suggests that this is the case.  (PLoS Article) The researchers conducted a “systematic review of systematic reviews” to assess the effect of these technologies on health care quality and safety.  They divided the functionality into three areas:  storing, maintaining and sending data; clinical decision support; and care from a distance or telemedicine. They identified 53 reviews which they examined and whose results they compiled.  Overall they found weak evidence at best for quality improvement, no real support for greater cost-effectiveness and some examples of greater risk created by implementation of HIT.

In regard to electronic health records, those responsible for storing and maintaining patient information, they found little applicable research.  The clinical decision support systems, such as e-prescribing or computerized physician order entry, had some support for reducing inappropriate care, but mixed effects on provider efficiency and on workflows.  While e-prescribing, for example, appears to reduce errors, it was not clear how serious most of these errors were and therefore how much patient quality was improved.  The authors noted that often studies which appear to have positive outcomes were done in provider environments which are not typical of most medical practice and that positive studies have received more attention than those with less positive results.

One of the obvious conclusions is that more research is needed not just to evaluate the effects of HIT, but also to guide its development, use and implementation.  Greater use of HIT is undoubtedly a good thing, but a lot of money has been and will be wasted on systems that really don’t make much of a difference.  Good research can provide guidelines for making these systems provide value to patients and providers.  A number of countries, including our own, have massive HIT projects underway, which seemed doomed to disappoint unless a pause is taken to better develop the research base and use the results to redirect these projects.