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Preliminary study shows electronic health record benefits hard to find

Interim results from a Harvard School of Public Health conference show that the presence of electronic health records has not significantly lowered costs or improved care.

Health care may be in crisis in the U.S., but no one should look to digitizing health care records for a quick cure. While it’s widely believed that the electronic health record (EHR) can improve the quality of care and lower its cost, interim results of a recent survey show otherwise.

The results flew in the face of conventional wisdom, as well as previous studies such as one by RAND Corp. in 2005 that proclaimed possible savings of $81 billion from computerized medical records. The survey findings were presented by Ashish Jha, associate professor at the Harvard School of Public Health (HSPH) at the recent 2009 Public Health & Technology Conference at HSPH in Boston.

The disconnect between the predicted benefits of electronic health records and actual results calls into question the soundness of spending billions in federal dollars to encourage EHR adoption. While the survey of 3,000 hospitals in 2008 did show very modest improvement among hospitals implementing EHR, Jha said the differences were not statistically significant compared with using paper records.

In response to the question “Does EHR yield better quality?” the replies from hospitals of varying size showed there was practically no improvement in care. That finding held true in cardiac care, pneumonia treatment, surgical infection rates and 30-day mortality, Jha found.

"The results are pretty underwhelming. EHR doesn’t seem to be associated with better quality,” Jha told the gathering.

In terms of cost savings, there was also negligible gain. Hospitals that had digitized records were able to have shorter patient stays -- but by such a slim margin that it was not statistically insignificant.

There is essentially no relationship between having EHR and having shorter stays,” said Jha. “We’re not seeing much of a relationship between having EHR and improvements in cost.”

The results are pretty underwhelming. EHR doesn't seem to be associated with better quality.

Ashish Jha, associate professor, Harvard School of Public Health

One mitigating factor to these contrarian results, Jha suggested, might be that since the EHR systems were recently adopted, their full benefits might not yet be realized. Another factor has to do with the financial incentives under which the medical industry labors. Those incentives tend for reward quantity over quality, Jha noted. As a result, the performance of hospitals will vary little even with digital records, until the incentive structure changes, he suggested.

Among the hospitals surveyed, 1.5% had fully functional EHR systems in place; 7.6% had basic electronic health records and 90.9% said they were not using EHRs. In general, the use of EHRs was more prevalent at large hospitals and teaching hospitals. Even hospitals with no electronic record systems in place, however, might be viewing lab results electronically and might be using an electronic prescription system.

Jha was careful to point out that electronic pharmaceutical records augmented by decision support systems have a track record of cutting errors and preventing adverse reactions among different medications. Those electronic pharmaceutical systems have typically been in place for a number of years, showing that a mature system can yield benefits.

Despite the findings, Jha said he is a strong supporter of the electronic health record. “We’re not getting the value we want [in health care]. Paper-based records are part of the problem,” he said. The inability to access key data at the point of care leads to errors, defensive medicine and redundant and unnecessary tests -- all of which inflate costs while eroding quality, he said.

But with the sobering results failing to justify the optimism of EHR proponents like himself, he warned, “Just having these systems in place is not going to be enough.”

Stan Gibson is a Boston-area technology writer. Let us know what you think about the story; email

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