EHR Adoption vs Quality of Care

As you're all probably aware, physicians are being enticed to purchase electronic health records (EHR) by both a carrot ($44K in Medicare incentives over 5 years if adopted by 2012) and a stick (penalties in the form of reductions in Medicare funding starting at 1% and climbing to 3% if not implemented by 2015).  Besides theoretical cost savings, another reason that's been proposed for adopting EHR is an increase in the quality of care delivered via clinical decision support (what should I do in this particular situation) and electronic guideline-based reminders (Mr/s. Jones is due for "x").

However, in a study just published online today, after reviewing over 255,000 ambulatory patient encounters, the authors found no association between EHR use and quality of care as denoted by previously developed & agreed upon quality indicators.  This is important because for physicians to receive reimbursement for their front-end purchase of said EHR, they must be able to document "meaningful use".  But what if "meaningful use" doesn't improve the quality of care provided?  Why purchase an EHR?

As with most scenarios, there's more than one perspective.  Perhaps there was no improvement because we're doing such a wonderful job of providing quality care already?  Now, don't everyone choke & gag all at once.  Or perhaps we can blame the EHR itself for not being user friendly.  After all, when an EHR is implemented, the physician/provider should not have to change his/her way of documenting the visit nor should the use of said EHR slow down the documentation process.  Yet, as the majority of EHRs are not designed with the end-user in mind, I hear too often that the EHR is really more a burden and hindrance than it is a boost to productivity and delivery of quality care.

We have to stop putting the cart before the horse and allowing the tail to wag the dog.  We need to speak up and let it be known how we want to interface w/our EHR to boost productivity and quality of care.  While there probably will never be one best EHR for every physician, we need to start looking critically at our options as our deadline looms closer & closer.

Disclosure:  I'm scheduled to give a presentation entitled "The EHR Challenge: How to Choose the Best Fit" this coming Thursday at our Nevada Academy of Family Physicians' 43rd Annual Winter Conference here in lovely South Lake Tahoe where the weather has been sunny and the skiing awesome.