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December 29, 2010

RAND Study Questions the Quality Impact of EHR Adoption

Electronic Health Record Adoption and Quality Improvement in US Hospitals, a December 2010 study published in the online American Journal of Managed Care challenges a widespread assumption that adoption of advanced electronic medical records will significantly increase the quality of patient care. In one of the first studies to analyze the impact of electronic records on patient health and quality of care, researchers at the Rand Corporation studied a wide mix of hospitals in the US, comparing the quality of care for patients being treated for heart failure, for heart attacks and for pneumonia.

The study included 2,021 hospitals—about half of the nonfederal acute care hospitals nationally. Researchers determined whether each hospital had electronic health records and then examined performance across 17 measures of quality for three common illnesses—heart failure, heart attack and pneumonia. The period studied spanned 2003 to 2007.

The study found that the quality of care provided for each of these three conditions improved in general among all types of hospitals studied from 2004 to 2007. The largest increase in quality was seen among patients treated for heart failure at hospitals that maintained basic electronic health records throughout the study period.

However, quality scores improved no faster at hospitals that had newly adopted a basic electronic health record than in hospitals that did not adopt the technology. In addition, at hospitals with newly adopted advanced electronic health records, quality scores for heart attack and heart failure improved significantly less than at hospitals that did not have electronic health records. Electronic health records had no impact on the quality of care for patients treated for pneumonia.

Researchers say the mixed results may be attributable to the complex nature of health care. Focusing attention on adopting electronic health records may divert staff from focusing on other quality improvement efforts. In addition, performance on existing hospital quality measures may be reaching a ceiling where further improvements in quality are unlikely. "With the federal government making such a large investment in this technology, we need to develop a new set of quality measures that can be used to establish the impact of electronic health records on quality," said Spencer S. Jones, the study's lead author and an information scientist at RAND, a nonprofit research organization.

Dr. Cronin is a Professor of Management in the Information Systems Department at Boston College. To read more of her articles, please visit her columnist page.

Edited by Erin Monda


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