South Florida Hospital News
Sunday August 25, 2019

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November 2007 - Volume 4 - Issue 5




EHR and Ambulatory Care

"As implemented, EHRs were not associated with better quality ambulatory care."

This sentence concluded the "Health Record Use and the Quality of Ambulatory Care in the United States" report that appeared in the July 9 edition of the Archives of Internal Medicine. Needless to say it created quite a stir among EHR Vendors. The study leading to this conclusion was part of the National Ambulatory Medical Care Survey in 2003 and 2004, which compared how physicians with and with out EHRs performed on 17 quality measures. Bottom line: Physicians with EHRs did about the same on 14 measures, better on 2, and actually worse on 1 measure.

The prominent authors from Harvard Medical School and Stanford University went to some effort to emphasize that the EHR technology may not be the major underlying problem. The implementation of that technology is critical to improving outcomes. Primary care and specialist physicians were both affected. Services that ranged from chronic disease care to acute care and preventive care were all affected. Like most studies, this one has significant limitations. The data were collected in 2003 and things have certainly changed since then.

The results of the July 2007 Archives of Internal Medicine Report conflict with a recently released systematic review conducted for the Agency for Healthcare Research and Quality. This AHRQ study found that Health Information Technology (HIT) systems, including EHRs, can increase the delivery of guideline-adherent care, improve quality of care through clinical monitoring, and reduce rates of medical errors. So how can we reconcile these very different conclusions?

1. Electronic Health Records are not "Plug and Play." Successful use and implementation requires careful strategic planning and "physician champion" leadership. EHRs will not improve quality unless a culture of quality is created within the practice and processes/workflows in the ambulatory setting are created, bought into by the staff, and followed consistently. Any effort less than this is technologically and operationally naïve. The bigger the investment on the front end, the better the outcomes.

2. EHRs are not created equally. Some have better features and functions than others.

3. EHR as a standalone technology is not the optimum clinical patient management technology. Improving ambulatory patient outcomes requires detailed knowledge about the disease-specific and preventive care needs of the patients. It requires the ability to identify patients who do not follow proven care guidelines. It requires recall programs and ways to communicate effectively with patients at their convenience, not the provider’s. Drill-down reporting of clinical data becomes crucial to success.

The final paragraph from the "Health record use and Quality…" report states this very well.

"In summary, although HIT and EHRs can improve quality, we found that EHR use was generally not associated with improved quality of ambulatory care. Our findings are not a refutation of previous studies. Rather, they suggest that as EHR use broadens, one should not assume an automatic diffusion of improved quality of care. In selecting an EHR, physician practices should carefully consider the inclusion of clinical decision support to facilitate quality care for individuals as well as the availability of tools, like quality reporting and registry functions, to facilitate quality care for populations."

MED3OOO has developed and deployed these population-based tools. We have the experience and suite of technology offerings to make your implementation successful in your quest to improve the quality of your communities, one patient at a time.

Dr. Paul McLeod, Chief Medical Executive of MED3000 and Dean of the Florida State University College of Medicine, Pensacola Regional Campus, can be reached at (850) 494-5939 or at
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