Yesterday, we commented on the “exuberance” of the reports on the recently released study that looks at the impact of EHR use on care for diabetes patients.
It seems only fair, then, to point to a piece which strikes us as at once supportive of, and optimistic about, EHRs, but which is also particularly clear-eyed about the challenges ahead.
These doctors are looking for the “meaning” in Meaningful Use. For starters, they don’t hesitate to point to healthcare organizations that have successfully used EHRs to improve their services. But there’s a catch.
“Most studies of the successful effect of EHRs on quality and safety of care,” they point out, “have come from four organizations that use internally developed EHRs that have been in place for more than 25 years: Brigham and Women’s Hospital in Boston, LDS Hospital in Salt Lake City, Vanderbilt University Medical Center in Nashville, and the Regenstrief Institute in Indianapolis. All four institutions have spent decades expanding, iterating on, and improving their EHRs and have shown improvements in safety, quality, and efficiency.
“Because these systems are under local control, the EHRs have been highly customized with the use of relatively rapid improvement cycles. They also have built informatics cultures of continuous quality improvement that allow for ongoing evaluation and iterative improvement.”
The problem is, they note, “such cultures have not been widely replicated in other organizations, and vendor applications do not facilitate customization to nearly the same extent.”
At the same time, “all these organizations . . . have struggled to maintain these systems, since doing so requires substantial development, and certification has further raised the bar. Several organizations with homegrown systems have discontinued them and purchased commercial systems, and nearly all future EHR implementations will probably involve vendor applications. However, the commercial EHR systems currently marketed are much younger than their homegrown counterparts and thus have been through far fewer improvement cycles.”
The piece is well worth reading in its entirety, as the writers do make some recommendations, but for our purposes it nicely highlights the fact that despite the myriad benefits they bring, EHRs will also bring no small amount of ongoing responsibility, particularly if the goal is to use them to improve continually the quality and safety of healthcare.
That’s a message that policymakers, providers, and the general public should probably hear a little more often.
