Electronic Records Don't Improve Outpatient Care, Stanford Study Indicates

Electronic health records don’t improve outpatient health care, even when paired with software that provides treatment tips, a Stanford University study found.

Doctors’ offices and outpatient clinics with electronic recordkeeping outperformed those using paper records on only 1 of 20 gauges of quality -- the frequency of providing diet counseling to high-risk adults -- researchers said today in a report released online by the Archives of Internal Medicine. Doctors whose software gave tips also performed better on only one indicator than physicians whose software gave none.

U.S. legislation in 2009 authorized the government to spend at least $20 billion to promote the adoption of electronic health records. The recordkeeping, while boosting administrative efficiency, isn’t sufficient to improve care on its own, said Randall Stafford, senior author of the study.

“We may need to reconsider the value of this investment that’s being made, and think about whether some of that investment might go toward improving other aspects of our health-care system that are going to be necessary for electronic health records to really have benefit,” said Stafford, an associate professor of medicine at Stanford, near Palo Alto, California, in a telephone interview on Jan. 21.

GE, Allscripts

Companies that may gain from the implementation of health- record technology include General Electric Co. of Fairfield, Connecticut; Allscripts Healthcare Solutions Inc. in Chicago; Cerner Corp. of Kansas City, Missouri; and Quality Systems Inc. of Irvine, California.

The research builds on a 2007 study that found electronic records alone didn’t improve health-care quality at doctors’ offices and outpatient clinics. For the new study, Stafford and a former Stanford undergraduate student named Max Romano analyzed data from government surveys on outpatient visits from 2005 to 2007. The data were extrapolated to the entire U.S. population.

Electronic records were used in about 30 percent of outpatient visits, according to the study. Clinical-decision software -- which provides tips, including suggestions for the best medicine for certain conditions -- was used in 17 percent of visits.

One reason that electronic records weren’t associated with improvements in health-care quality is that doctors may have needed more training to reap the benefits of their systems, Stafford said. To make the recordkeeping more effective, the way physicians are paid could focus more on quality and outcomes rather than services rendered, he said.

Enormous Potential

“It may be a situation where electronic health records and clinical decision software have enormous potential but perhaps some other things have to happen first before we can fully take advantage of those technologies,” Stafford said.

Jeffrey A. Linder, lead author of the 2007 paper -- which also was published by the Archives of Internal Medicine -- said electronic health records are a “good investment.”

“The general idea is to get more doctors using electronic health records and then we can set the bar a little higher for the quality of care Americans are receiving,” said Linder, an assistant professor of medicine at Harvard Medical School and an associate physician at Brigham & Women’s Hospital in Boston, in a telephone interview on Jan. 21.

To contact the reporter on this story: Nicole Ostrow in New York at nostrow1@bloomberg.net.

To contact the editor responsible for this story: Reg Gale at rgale5@bloomberg.net