Health Information Technology

Studies explore the use and functions of electronic health records

Less than one-fourth of U.S. physicians use electronic health records (EHRs), even though they have great potential to improve health care quality and safety. For example, EHRs can keep medication records in an easily accessible format, flag drug interactions and allergies, and prevent medical errors and adverse drug events. EHRs also have the potential to evaluate quality of care. Two studies supported by the Agency for Healthcare Research and Quality recently examined the use of EHRs.

The first study (HS15397) found considerable variability in the functions available in EHRs and in the extent to which physicians used them. According to the second study (HS13690), automated review of EHR data on quality of care of outpatients with heart failure sometimes underestimated performance on medication-based quality measures. The two studies are briefly discussed here.

Simon, S.R., Kaushal, R., Cleary, P.D., and others (2007, March). "Physicians and electronic health records: A statewide survey." Archives of Internal Medicine 167, pp. 507-512.

Physicians vary considerably in the EHR functions they have available to them and the extent to which they use EHRs and various EHR functions, conclude the authors of this study. They surveyed a random sample of 1,884 physicians in Massachusetts to assess the availability, use, and perceptions of EHR use in physicians' medical practices.

Of the 1,345 physicians who responded to the survey, 29 percent said their practice had adopted EHRs. More than 80 percent of physicians with EHRs said they had the ability to view laboratory reports (85 percent) and document visits electronically (84 percent). However, considerably fewer physicians reported being able to order laboratory tests electronically (47 percent) or transmit prescriptions to a pharmacy electronically (45 percent).

Fewer than half of the physicians with EHRs with clinical decision support, transmittal of electronic prescriptions, and radiology order entry actually used these functions most or all of the time. Compared with physicians who had not adopted EHRs in their practices, EHR users had more positive views of the effects of computers on health care. However, there were no significant differences in these attitudes between high and low users of EHRs. EHR adoption or use did not seem related to physician dissatisfaction with medical practice.

Baker, D.W., Persell, S.D., Thompson, J.A., and others (2007, February). "Automated review of electronic health records to assess quality of care for outpatients with heart failure." Annals of Internal Medicine 146, pp. 270-277.

This study evaluated the accuracy of automated review of EHR data to measure the quality of care for 517 outpatients with heart failure at a general internal medicine clinic. The review was followed by manual review of electronic notes for patients with apparent care quality deficits. Care performance based on automated review of EHR data was similar to that of manual review for assessing left ventricular ejection fraction (94.6 vs. 97.3 percent), prescription of beta-blockers (90.9 vs. 92.8 percent), and prescription of angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers (93.9 vs. 98.7 percent). However, performance based on automated review was lower than that based on manual review for prescription of warfarin for atrial fibrillation (70.4 vs. 93.6 percent). This was primarily because automated review did not detect documentation of accepted reasons (contraindications) for not prescribing warfarin. Thus, automated review of EHR data to measure the quality of care for outpatients with heart failure missed many exclusion criteria for medications documented only in providers' notes. As a result, it sometimes underestimated performance on medication-based quality measures.

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