Medical News Today recently published a round-up of studies related to the efficacy of health information technology. Among the findings:
-A study published in the journal Health Affairs found that the use of computerized physician order entry and electronic health records (EHR) led to significant improvements in two quality measures. The benefits were greater in academic than nonacademic hospitals. However, the study concluded that it might take a while for U.S. hospitals to see substantive benefits from the implementation of national health IT.
-Computerized physician order entry had mixed results, according to another study published in Health Affairs.
-A survey conducted by the Center for Studying Health System Change discovered that EMRs could both help and hinder patient-doctor communication. Physicians who participated in the survey said that the computer could distract them from their patients. Respondents also said that they engaged with patients less because the EMR provided them with so much information prior to seeing the patient. On the other hand, respondents said that EMRs aided in patient education, and the use of email strengthened their relationship with their patients.
“The most important thing is for the doctor to use the electronic record as a tool rather than as a hindrance,” says Charlie Jarvis, VP of Healthcare Services and Government Relations at EHR provider NextGen. Jarvis has seen physicians quickly document the necessary information and go back to the patient. He has also witnessed physicians using the electronic record as a support tool, not only showing the patient how the physician is documenting care, but also sharing health-related literature. In this way, patients can become more engaged in their care.
When it comes to efficacy, things are a little murkier. Why do some clinics save time and improve the quality of care, while others find themselves bogged down in electronic paperwork? EHRs can fail for any number of reasons: lack of effective leadership, too many changes too soon, poor communication between the IT folks and clinicians, staff resistance to technology, inadequate training, or not adapting the technology to the specific needs of the organization. Jarvis says that when it comes to both cost and efficacy, organizations need to change the way they do business, recognizing that certain processes will differ in the transition from a paper-based to an electronic system. “If you try to automate a paper process, you’re never gonna be successful,” says Jarvis. He gives the example of data security: Paper records are easy to lose; they can be misfiled or walked off with. Electronic records have stricter access than paper records, but everybody with the appropriate password has the capability of viewing the same record. Jarvis says that patients, physicians, regulators, and other authorities all need to adopt a different way of dealing with the security of patient records.
Not only do medical organizations need to make adjustments, the entire team needs to participate. Sameer Bhat, co-founder and vice president of sales at EMR vendor eClinicalWorks, says that there must be an “organizational buy-in” when switching from paper charts to an electronic system. Someone should manage the changes within the organization, and the physician’s input should be considered, says Bhat. “If you do not include the physician’s input into that change process, then the physicians many times do not buy into that change you are making.”
eClinicalWorks was used by one of the recipients of the 2009 HIMSS Davies Award, which honors healthcare organizations who have demonstrated excellence in the implementation of information technology. GE Healthcare and Epic were among the other vendors used by this year’s recipients. You can read the winners’ applications and view video testimonials discussing their successful IT implementations here.
We’d like to hear your take on the subject of efficacy. Why do some healthcare organizations fail at using EHRs while others succeed? How can organizations successfully implement electronic records?