by Jane Sarasohn-Kahn
“Electronic Health Records Didn’t Improve Quality of Outpatient Care”
“Electronic Health Records Don’t Lift Care”
“Electronic Records Don’t Always Improve Care”
“No Quality Benefits Seen with Electronic Health Records”
“Electronic Medical Records May Not Live Up to Hype”
So said some of the newspaper headlines about the July 9 Archives of Internal Medicine paper, “Electronic Health Record Use and the Quality of Ambulatory Care in the United States.”
When I read the news coverage emanating from the study, it caught me — and I suppose many of you readers — off guard. I’m not one to bash the mass media, but reporters got this latest study on electronic health records and outcomes wrong. Journalists need a quick course in statistics, and perhaps simple reading mastery, to know the difference between causality and simple association.
A highly credible and switched-on team from Harvard and Stanford universities wrote the study, which the Agency for Healthcare Research and Quality funded. For the study, researchers studied data from the 2003 and 2004 National Ambulatory Medical Care Survey published by CDC. The data set detailed EHR use coupled with 17 ambulatory care quality indicators. These indicators covered medical management of common diseases, antibiotic prescribing, preventive counseling, screening tests and other services. According to the analysis, physicians’ performance on these quality indicators was not associated with the “use” of an EHR system.
All you have to do is read the second sentence in the paper abstract’s background paragraph to realize that the researchers were assessing “the association between EHR use, as implemented, and the quality of ambulatory care in a nationally representative survey.” Herein lies the nuance of the study: the authors did not seek to address whether the installation of an EHR would result in better outcomes, as newspapers incorrectly interpreted. They simply sought an association between EHRs and quality of care — and that they did not find.
It’s also important to closely look at the second half of that introductory sentence: the simple phrase, “EHR use, as implemented” (emphasis added). That is the point.
So, before you swallow the mass media line of reasoning that “EHRs don’t work,” take a few minutes to understand what’s really in the study.