Federal officials often tout the supposed benefits of its Meaningful Use electronic health records program, namely that physician adoption of these EHRs in their practices is leading to improved healthcare delivery and outcomes. However, so far, the evidence doesn't appear to support the association between physician use of MU EHRs and quality of care.
Case in point: Brigham and Women's Hospital in Boston, whose doctors have been spearheading the EHR effort, has achieved mixed results when it comes to an important MU criteria--quality. A study published April 14 in JAMA Internal Medicine of 858 doctors at the hospital and its affiliated ambulatory practices--all of whom were using EHRs--found no connection between MU and quality for seven clinical quality measures included in the federal government's program.
Though meaningful users provided slightly higher quality of care for two of the measures and similar measures for three compared to non-meaningful users, they also demonstrated worse quality for two measures. Of the study group, 540 of the physicians met the MU criteria while the remaining 318 doctors did not.
"This study raises important questions about how to measure the effects of MU and whether MU improves quality," states a commentary by Weill Cornell Medical College's Lisa M. Kern, M.D., and Rainu Kaushal, M.D., noting that additional studies are needed. "The Brigham and Women's Hospital is a national leader in the use of EHRs to improve quality and safety, and their physicians have extensive experience using a home-grown EHR" but "other studies are needed in settings that are typical of the rest of the country, including community-based settings with commercially available EHRs," argue the authors.
Similarly, in an April 8 Health IT Policy Committee meeting, Jennifer King, acting director of the office of economic analysis, evaluation and modeling in the Office of the National Coordinator for Health IT, told the committee that critical access hospitals and small urban hospitals have been less likely to attest to Stage 1 meaningful use EHR than small rural hospitals, medium-sized hospitals and large hospitals. Nevertheless, King also said that the "widespread adoption of meaningful use" is improving healthcare delivery and outcomes.
"We've presented data in the past several months to the committee that has shown early evidence that there is a positive association between meaningful use objectives and healthcare outcomes," she said. "We've seen a recent systematic literature review that found that the majority of studies that have been published in past years have found positive associations between meaningful use objectives and functionalities and healthcare safety, quality, and efficiency outcomes. And, we've also seen data from some physician surveys that show physicians are reporting that when they use meaningful use-certified EHRs they are reporting that that their EHR use has led to clinical benefits in their practice."
King asserts that ONC has seen "good data" on Stage 1 but the "burning question is whether or not we will continue to see these same patterns in 2014" as providers continue with Stage 1 attestation and move into Stage 2.
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