Health IT benefits becoming more apparent

A recent study finds that evidence of the benefits of health information technology are emerging for small practices. But the study, which reviewed previous looks at health IT, noted that the benefits don't always translate into physician satisfaction with electronic medical records.

For the article, in the March Health Affairs and co-written by David Blumenthal, MD, national coordinator for health IT, researchers analyzed 154 peer-reviewed studies from 2007 to 2010 that looked at health IT. Unlike similar studies looking at earlier research that often found negative effects of EMRs, they found that 92% of the articles reached positive conclusions (link).

Of the studies analyzed, 96 showed post-implementation improvements in one or more aspects of care, with no aspects worse off. About 140 of the studies, including the 96 with no aspects worse off, found either positive or mixed-positive outcomes, meaning researchers found a positive conclusion overall, but the article demonstrated at least one negative aspect of health IT. The aspects of care the studies looked at were access to care, preventive care, patient satisfaction, patient safety, and effectiveness and efficiency of care.

The report's findings may be one of the green lights some practices are waiting for to buy technology, said Melinda Buntin, PhD, director of the Office of Economic Analysis, Evaluation and Modeling at the Office of the National Coordinator and co-author of the report.

"Physicians are very evidence-driven," she said. "They read medical literature, and they want to know what it concludes. The literature on this area has been voluminous and, as we say in the article, has been focused on larger health systems. But now the literature has really expanded, and we were able to say that there were benefits being shown outside of those large systems."

It comes at a good time, the authors note, because physicians are feeling pressure from the federal government to adopt EMRs and offered incentives to do so. Physicians can earn bonuses up to $44,000 from the Medicare program, or up to $63,750 from Medicaid for installing and using an eligible EMR system.

Studies similar to the one published in Health Affairs have failed to find conclusive evidence that EMRs bring the benefits many proponents tout. A report by British researchers, published online Jan. 18 in PloS Medicine, examined 55 studies from 1997 to 2010 and found a lack of evidence that technology could improve care (link).

Buntin said one explanation for the differing conclusions might be the evolution of the technology. Systems have matured and are better designed to complement the way physicians practice, she said.

But the studies that looked at satisfaction were less likely to reach positive conclusions. In those studies, physicians often were found to be dissatisfied with the technology or the support they received.

Of the studies that did not address satisfaction, the most negative findings related to work-flow implications of implementing health IT such as order entry, staff interaction and physician-to-patient communication.

"We know that the theory that health information technology is vital and the practice of making it useful are two different things," Dr. Blumenthal said March 8 at the Health Affairs issue launch party in Washington, D.C. "And that practical challenge is one our office confronts every day."

"It does require change and work to implement a system. We're not pretending it's easy. There's an implementation hurdle to get over. ... It affects the way you interact with data about your patients."

She said the encouraging thing is that many surveys have found that even though it's hard to adapt to the new technology, physicians who have gone through the process say they don't want to go back to paper.