November 16, 2009
Little Benefit Seen, So Far, in Electronic Patient Records
By STEVE LOHR
The nation is set to begin an ambitious program, backed by $19 billion in government incentives, to accelerate the adoption of computerized patient records in doctors offices and hospitals, replacing ink and paper. There is wide agreement that the conversion will bring better care and lower costs, saving the American health care system up to $100 billion a year by some estimates.
But a new study comparing 3,000 hospitals at various stages in the adoption of computerized health records has found little difference in the cost and quality of care.
The way electronic medical records are used now has not yet had a real impact on the quality or cost of health care, said Dr. Ashish K. Jha, an assistant professor at the Harvard School of Public Health, who led the research project.
The research is to be presented on Monday at a conference in Boston. It is a follow-on study to a survey of hospitals adoption of electronic health records, published this year and financed by the federal government and the Robert Wood Johnson Foundation.
Dr. Karen Bell, a former senior official in the Department of Health and Human Services and an expert in health technology, said she was not surprised by the research. Very few hospitals today are effectively using the capabilities of electronic health records, she observed.
There will be no clear answers on the overall payoff from the wider use of electronic health records until we get further along, five years or more, said Dr. Bell, senior vice president for health information technology services at Masspro, a nonprofit group. But that doesnt mean we shouldnt go forward.
The study is an unusual effort to measure the impact of electronic health records nationally. Most of the evidence for gains from the technology, Dr. Jha said, has come from looking at an elite group of large, high-performing health providers that have spent years adapting their practices to the technology. The group usually includes Kaiser Permanente, the Mayo Clinic, the Cleveland Clinic and Intermountain Healthcare, among others.
But the new study, led by Dr. Jha and Catherine M. DesRoches of Massachusetts General Hospital, suggests that these exceptions mostly point to the long-term potential of electronic health records, properly used.
The research also underlines the challenge facing the Obama administration as it seeks to accelerate the adoption of electronic health records through 2015, even though only about 20 percent of physicians now use them. And the research shows that installing the technology does not necessarily mean that the hoped-for gains in quality and cost containment will follow quickly.
Under the administrations plan, doctors and hospitals will receive incentive payments for meaningful use of certified records. The standards will not be complete until the end of the year, but they will include requirements for reporting, data-sharing, alerts and decision-support features that get more stringent year by year.
The new study placed hospitals into three groups: those with full-featured electronic health records, those with more basic ones, and those without computerized records. It then looked at their performance on federally approved quality measures in the care of conditions like congestive heart failure and pneumonia, and in surgical infection prevention.
In the heart failure category, for example, the hospitals with advanced electronic records met best-practice standards 87.8 percent of the time; those with basic computer records, 86.7 percent; and those without, 85.9 percent. The differences in other categories were similarly slender.
Reducing the length of hospital stays, according to many experts, should be a big money-saving payoff from electronic health records as better care aided by technology translates into less time spent in hospitals. For hospitals with full-featured digital records, the average length of stay was 5.5 days; for those with basic computer records, 5.7 days; and those without, 5.7 days.
The differences, Dr. Jha said, were really, really marginal.
To Dr. Bell, the results of the study suggest that government policies should focus on helping physicians, hospitals and the public health system use the technology more effectively.
Its not going to be easy or quick, Dr. Bell said, but the better information at the point of care, the better health care we will have.
