A study published this month in the journal Health Affairs found that access to electronic medical record data may be crucial to radiological decision making in the emergency department setting. The study is a call to health care providers to be aware of the value of EHRs and the possible harm that could result if they're not implemented.

"In my mind, it would be below the standard of care to practice radiology and to interpret imaging studies without access to the EHR," Dr. John Ulmer, one of the researchers and a professor of radiology at the Medical College of Wisconsin, told DOTmed News. The college has been using it for years and they've witnessed how much it improves patient care and the ability to diagnose, as well as guide further workup and therapies, he said.

When the Health Information Technology for Economic and Clinical Health (HITECH) Act approved almost $30 billion in funding to support the adoption of EHRs that meet federal meaningful-use requirements, many hospitals rushed to implement EHRs.

However, there is still a large discrepancy in the rate that providers are adopting EHRs, especially among those who are ineligible for federal incentives, according to the study. Additionally, there has been a great interest in telemedicine, which is led by teleradiology, but for the most part it is developing independent of EHR implementation.

For the study, three neuroradiologists conducted a prospective analysis of 2,000 consecutive head CT exams that were ordered by emergency department physicians. For each exam, the neuroradiologists compared the medical information created by the ED physicians with information created by the interpreting radiologists who had access to EHR data.

The researchers who studied the neuroradiologists' analyses found that in 6.1 percent of the exams two out of three of the neuroradiologists agreed that the additional EHR data was "very likely" to have an impact on the radiologists' interpretations, and if they didn't have access to the additional data, it would have an adverse affect on the medical management of those patients.

Meaning that in those cases a radiologist could have recommended inappropriate further imaging, failed to recommend appropriate further imaging or failed to give an accurate diagnosis. Furthermore, the neuroradiologist with the most experience reported that 13.4 percent of the exams without access to EHR information would have adversely affected medical management.

Ulmer said it's important to note that this is not an outcome study — it's a theoretical estimate of the impact of EHR on emergent head CT interpretations instead of a study that shows the actual impact of not having EHR access. In that case, EHR information from a group of patients would have needed to be withheld.

"That would be unethical because we know how powerful it is," said Ulmer.

Ulmer hopes that the findings of the study will have an effect on how providers feel toward EHR implementation. "What we hope will happen is that health care providers will recognize, on a more wide-scale basis, the value of implementing the EHR and the potential harm that may come from absence of EHR access," he said.

He also hopes that teleradiology and access to the EHR will be more integrated. "Providers have to recognize that the quality of teleradiology may differ from in-house radiology if access to the EHR is not provided to the teleradiology companies or teleradiology services," he said.

Ulmer would like to see a more wide-scale study conducted in the future. "Larger studies across multiple institutions and multiple scenarios would give us a better appreciation for how well this reflects the impact of the EHR on interpretations of imaging studies elsewhere or in other scenarios," said Ulmer.