Use of electronic health records by physicians could result in modest gains in patient care, according to a paper published in the Annals of Internal Medicine.

Researchers affiliated with the RAND Corporation and Brigham and Women's Hospital found that among primary care practices, different so-called structural capabilities, such as having multifunctional electronic health records (EHRs) and giving performance feedback to doctors, appeared to bring real, if small, benefits to patients.

How the study worked

Using items drawn from the Health Effectiveness Data and Information Set (HEDIS), a family of measures widely used to evaluate health care delivery, the researchers assessed the quality of patient care at 305 physician offices and clinics across Massachusetts.

Mainly, HEDIS measured the rate at which certain evidence-based practices were performed: preventive screenings for cancers and treatable infections, recommended routine exams for diabetics, (lack of) overuse of imaging and antibiotics, and therapeutic management of depression.

The team found that using electronic records had a significant, if modest, impact on diabetes care and preventive screenings, with performance rates of indicated services improving by 3.1 to 7.6 percent.

"The three screening measures for which advanced EHRs were associated with better performance were screening for breast cancer, colorectal cancer, and chlamydia," Mark Friedberg, an associate natural scientist at RAND, and lead author of the study tells DOTmed News, noting that the greatest performance boost seen in the whole study was in chlamydia testing. "The two measures of diabetes care for which practices with advanced EHRs did better than those without such EHRs were eye examinations (screening for diabetic retinopathy) and nephropathy [kidney disease] monitoring."

Nonetheless, of all the structural capabilities investigated in the study, using EHRs appeared to bring about the biggest improvements, exceeding those from frequency of patient meetings or even of doctors being aware of what their patients were going through.

Do EHRs lead to healthier patients?

It's unknown what, if any, benefit EHR is really having on the patients in the study. "All of the investigated HEDIS measures are 'process measures,' which means that they measure the frequency with which primary care practices deliver care that is concordant with evidence-based guidelines," Dr. Friedberg notes. "We did not have data on outcomes of care in this study (such as incidence of cancer or complications of diabetes). You might say that the services we measured are necessary but not sufficient for the ultimate delivery of high-quality primary care."

As for why diabetes and screening topped the list, but not depression management, it could be because the companies that design EHR software "might be prioritizing reminder functions that target screening and diabetes measures," Dr. Friedberg notes. The reason? EHR makers are catering to their audience: Routine testing for STDs and cancer, as well as diabetes procedures like eye exams, are favorite targets of "pay-for-performance" and public performance reporting, according to Dr. Friedberg, so doctors might want to be reminded to do them.

EHRs need to have advanced features

"A primary care clinic should not expect an EHR to be a 'quality panacea,'" Dr. Friedberg cautions. "It seems unlikely that adopting an advanced EHR would take a practice from, say, 60% to 90% performance on any of the measures we investigated. Other efforts to improve performance would also probably be needed."

But if clinics trade their paper for silicon and are looking for a boost in performance, they should search for systems with advanced features, Dr. Friedberg argues, which incorporate laboratory and radiology results, medication and event lists, and medical record notes. In his study, clinics using more basic EHRs, with only lab and radiology results, saw smaller performance gains across fewer quality measures.

The Annals of Internal Medicine paper ran October 6. This report originally appeared in DOTmed News October 9.