EHR use doesn’t appear to improve quality, outcomes in stroke

Despite all their promise, EHRs failed to deliver in a study that compared the quality of care and outcomes for ischemic stroke at hospitals that had and had not adopted the technology. The results were published in the May 12 issue of the Journal of the American College of Cardiology.

The Health Information Technology for Economic and Clinical Health Act was designed to nudge hospitals into the electronic era, initially with financial incentives for adopters and later with penalties for laggards. Karen E. Joynt, MD, MPH, of Brigham and Women’s Hospital in Boston, and colleagues reasoned that stroke provided a prime opportunity for assessing EHRs’ effect on quality and outcomes, given updated guidelines and an increasing focus on performance metrics.

They used two resources for their study: stroke hospitalization data from 2007 to 2010 in the Get With the Guidelines-Stroke registry and EHR adoption and use data from the American Hospital Association’s Health Information Technology Survey. They looked at both clinical and quality outcomes.

The study included 626,473 patients with acute ischemic stroke at 1,236 hospitals in the U.S. EHR adoption increased over time, from 8.7 percent of hospitals meeting basic EHR criteria in 2007 to 38.4 percent in 2010.

They found no difference in outcomes for patients treated at hospitals with or without EHRs in unadjusted analyses. After adjusting for hospital and patient characteristics, they reported no association between EHR status and better quality of care or most clinical outcomes, with one exception:  The odds of a length of stay shorter than four days was slightly better for patients in hospitals with EHRs.

“Although EHRs may be necessary for an increasingly high-tech, transparent healthcare system, they do not appear to be sufficient, at least as currently implemented, to improve overall quality of care or outcomes for this important disease state.” Joynt et al wrote.

It is possible the way EHRs are designed or implemented has burdened clinicians or impeded EHRs’ potential to improve care and outcomes, they suggested. Increasing adherence to guidelines by hospitals may be affecting quality and outcomes, independent of EHR use, as well.

They also pointed out that EHRs may facilitate care in other ways such as by improving communication with primary care physicians and other care givers after the patient is discharged or by helping hospitals track patients through the healthcare system.