Jury still out on whether EMRs improve patient care

A study finds a lack of research showing the cost-effectiveness of using technology, despite claims of cost-effectiveness being a given.

By Pamela Lewis Dolan — Posted Feb. 7, 2011

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Thirteen years of studies have not proven that health information technology can improve the quality of care -- but they also haven't proven that it can't, according to a group of British researchers.

More research is needed into the good and bad of health information technology systems, researchers say, so that future implementations have a better chance of success. And some of the largest implementations in history -- the national health information networks under construction in Britain and the U.S. -- will provide opportunities for learning, they say.

Aziz Sheikh, professor of primary care research and development with the Centre for Population Health Sciences at the University of Edinburgh Medical School, and nine other U.K.-based researchers reviewed 55 studies conducted from 1997 to 2010 that looked at the impact of adopting health information technology.

The study, published online by the journal PloS Medicine in January, concluded that there is a lack of research showing the cost-effectiveness of using technology despite claims that make cost-effectiveness seem like a given. That does not mean the systems are ineffective, they say, but more research is needed into possible risks and rewards of implementing the systems. The studies they reviewed looked at different types of technology, including EMRs, e-prescribing, clinical decision support systems and telehealth technologies.

Sheikh said reviews of a technology's effectiveness are needed through all stages of the system's life cycle. The "fit" of the technology into each clinical setting is key to effectiveness, he said. "If technology interferes with clinical workflows and hinders rather than supports physicians, as often seems to be the case, it is most unlikely to achieve the desired objectives."

The researchers wrote in the study that reports of negative consequences will help others evaluate the risks as they move toward implementation.

"Promising technologies, unless properly evaluated with results fed back into development, might not 'mature' to the extent that is needed to realize their potential when deployed in everyday clinical settings," the authors wrote.

They said there is a lot to learn from deployments under way. In particular, the U.K.'s $13 billion health information network and the United States' current plans to launch a national health information network "offer unparalleled opportunity not just for improving health care systems but also for learning how to [or how not to] implement e-health systems and for refining these further once introduced."

David Shrier, CEO of HCPlexus, a referral and consultation network for physicians, said physicians' skeptical attitude about technology may be contributing to the lack of effectiveness.

HCPlexus recently surveyed nearly 3,000 physicians on various aspects of health reform. When asked how they believed EMRs would affect patient care, 24% thought the technology would have a negative impact. Thirty-nine percent said it would have a positive impact, and 37% were neutral.

"If you have a resistant user base, it's hard to get them to use the system effectively," Shrier said.

However, Sheikh disagrees with that argument. He said most physicians aren't technology-averse, so long as the systems they use are a good fit for them.

Sheikh said there was some evidence that e-prescribing systems became more effective as the technology matured. He said more recent studies of e-prescribing systems showed more positive effects than older studies.

He said this is likely because "of greater system maturity, better interoperability and improved appreciation that decision support needs to be presented in real time with due recognition of the importance of human factor considerations such as displays and override options." Sheikh said there was less evidence of such a progression in EMR use.

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External links

"The Impact of eHealth on the Quality and Safety of Health Care: A Systematic Overview," PLoS Medicine, January (link)

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