Do Electronic Health Records Deliver on Their Promise?

Health care providers all over the United States are converting from paper-based health record systems to electronic health records (EHRs). Increasing the use of EHRs, both through the stimulus bill and in health reform, was a priority for President Barack Obama’s administration. But the transition from paper to electronic records does not come without challenges. EHRs require physicians to learn more than a new way of documenting their medical notes. They sometimes require a fundamental examination of workflow in the physician’s office or hospital.

“EHRs are an effective tool that can be used to improve quality of patient care when adopted correctly,” said Kimberly Lynch, senior health information analyst for Altarum Institute. “If you simply lay a piece of technology over an inefficient process, you end up with a marginally better electronic version of an inefficient process. However, if you use an EHR implementation to examine and adjust workflow … you can achieve the specific outcomes your practice is looking to achieve.”

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This week’s post is the fifth in Jennifer Ecklund-Johnson’s series on health care delivery following health care reform. Ecklund-Johnson’s features will provide an in-depth analysis of the impact of health reform on various sectors of the health care provider community, including hospitals, specialists, and others. Look for her next article in January.

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Altarum manages M-CEITA, Michigan’s federally-designated and funded health IT regional extension center (REC). Altarum, through M-CEITA, assists medical providers throughout the adoption process of an EHR, from selecting and adopting an EHR to meaningfully using it to improve the quality of care delivered to their patients.

While the process of adopting a new EHR system or transitioning from one EHR system to a newer integrated system is potentially time consuming, disruptive, and costly, health care providers are finding the benefits far outweigh the temporary challenges of the transition. The goals of adopting an EHR vary by provider, but may include any number of factors, including improving patient care and safety, increasing accuracy and efficiency, improving the patient experience, creating greater transparency, providing data for quality improvement initiatives, and making sure bills are generated correctly.

Perhaps one of the most compelling reasons for providers to adopt EHRs at present are the significant financial incentives offered by Medicare and Medicaid. The federal government, through the stimulus bill enacted in Congress, is channeling tens of millions of dollars to the medical field to encourage the adoption of EHRs, with providers eligible for several thousand dollars in reimbursement for EHRs that meet the “meaningful use” criteria established by the Office of the National Coordinator for Health IT. Although the incentives through Medicare and Medicaid may not be the primary driving force for all health care providers to adopt EHRs, they are certainly a strong factor.

“I believe that providing a higher quality of care and more efficient care to their patients is first and foremost in physicians’ minds,” said Sallie Cook, MD, chief medical officer for Virginia Healthcare Quality Center (VHQC), a health consultancy and the state-sanctioned quality improvement organization for Virginia. VHQC also runs Virginia’s REC, the Virginia Health Information Technology Regional Extension Center. “But obviously a part of the equation is the current financial incentives that Medicare and Medicaid are offering to providers who have a system that meets the currently defined meaningful use standards.”

“We certainly are paying attention to the meaningful use [financial] incentives,” said Mark D. Kelemen, MD, senior vice president and chief medical informatics officer at the University of Maryland Medical System. The University of Maryland Medical System is in the process of consolidating multiple EHR platforms in the hospital setting and also rolling out office-based EHRs in the offices of their physician faculty members. “Where appropriate, we match our EHR strategy with qualifying for the incentive dollars. However, we are not altering our overall strategy to try to chase the stimulus dollars.”

EHRs, however, do offer more than just cash incentives for providers. Quality improvement efforts are just one of many ways that health care providers are taking advantage of the tools provided by EHR systems. EHRs can improve workflows and information sharing, speeding information awareness in ways that would simply not have been possible in the days of paper records.

“Last year during the flu epidemic, we targeted inpatient influenza vaccination as one of our quality objectives,” said Thomas R. Yackel, MD, chief health information officer, Oregon Health & Science University. “Through our EHR system we had access to daily information on patients who were discharged and whether or not they received a flu shot. We were able to rapidly develop a workflow that made it easy to ensure patients were offered the influenza vaccine. In a paper world, we would have had to look at the data monthly instead of using that daily data to tweak our workflow. So EMR [electronic medical records] really shortens the cycle time to improvement.”

“Safety and quality are ongoing struggles that EHR helps us address,” echoes C. T. Lin, MD, chief medical information officer and associate professor, University of Colorado Denver School of Medicine. “Not only do we have our internal metrics, but there are numerous external and governmental agencies with mandates to require—for example—fall risk screening, smoking cessation counseling, pain score evaluation, and depression screening. Those items we have focused on, we have done well.” The University of Colorado Denver is transitioning from an older EHR to a new system that can integrate health information from their clinics, hospital, and emergency department, where they have been using separate EHRs.

A variety of patient populations stand to benefit from the use of integrated EHR systems, such as patients with chronic conditions. “One of the key benefits of adopting EHR is being able to track our chronic disease patients,” said Maryland’s Dr. Kelemen. “One of our early practices that went live in an underserved area in West Baltimore has been able to get accredited as a patient-centered medical home and a specialized diabetes care center as a result of their ability to do their reporting out of an EHR.”

EHRs also have the potential to be a game-changer in the coordination of care for patients with a long-term or chronic illness, where EHRs can serve as a central information sharing point. EHRs can also be utilized to provide detailed decision support, including checking whether drugs interact with each other and checking whether the drug doses are correct.

“When patients deviate from the expected trajectory or aren’t getting the care we would expect, the EHR system may help by ultimately contacting the patient directly, but also by contacting the provider or influencing the provider while the patient is in front of him or her,” said Stephen M. Borowitz, MD, professor of pediatrics and public health sciences and associate director of medical informatics at University of Virginia Health System. “Also, for patients with multiple problems who are cared for by multiple physicians, having a single source of truth facilitates communication.”

Perhaps one of the unexpected advantages of the increasing use of EHRs is that they do not seem to benefit just doctors and providers. With the rapid growth of information sharing online and through other technologies, patients are increasingly comfortable dealing with—or even demand—greater information about their medical conditions and care. Many health care providers are even choosing to give their patients access to a version of their electronic health record, and both Microsoft and Google have launched online patient medical records systems in just the past few years designed in part to provide individuals with greater access to their personal medical information.

“We release our patients’ lab results for them to view and we also keep track of periodic and preventative care they need,” said Dr. Yackel. “Prior to EHR, I never had a patient come in to their appointment and tell me they are due for a colonoscopy, but it happens now. So our patients are becoming more engaged in their health care through this technology.”

Perhaps the central question about EHRs is whether they truly hold the promise of transforming patient care in a way that will help reduce costs, one of the overwhelming rationales for the significant financial incentives being provided for their adoption. On that complex issue there remains great uncertainty. As with so many other technologies—such as personal computers or instant cellular communications—EHRs may indeed transform certain business processes, but that may not mean an increase in efficiency or a cut in workload.

“The idea that EHR is going to make providers more productive probably is not true,” said Dr. Kelemen. Others in the field express similar sentiments.

“The only real reason to adopt EHR is to provide better and safer care for our patients,” said Dr. Borowitz. “I believe there are a lot of different ways we might see cost savings as a result of adopting an EHR system, but I don’t think it will be through increased provider efficiency.”

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Special Contributor Jennifer Ecklund-Johnson is a freelance health care writer, and focuses on the impact of health reform on health care delivery in the United States. “Special Contributors” are regular contributors to the Health Policy Forum who pose their own opinions and policy positions in the realm of health care and health policy. As a leading nonprofit health care research and consulting institute dedicated to improving human health, Altarum encourages open discussion and debate about the many challenges in health care today. All postings to the Health Policy Forum (whether from employees or those outside the Institute) represent the views of the individual authors and/or organizations and do not necessarily represent the position, interests, strategy, or opinions of Altarum Institute. Altarum is a nonprofit, nonpartisan organization. No posting should be considered an endorsement by Altarum of individual candidates, political parties, opinions, or policy positions. Read More.