Electronic Health Records

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Physician EHR Use Vital in Healthcare Quality Improvement

By Vera Gruessner

When considering EHR integration, the way physicians use certain EHR features should be addressed, as there may be key differences among a group of doctors. Physician EHR use could correlate with the costs and quality of care at medical facilities.

A study from the Journal of the American Medical Informatics Association (JAMIA) found that healthcare providers using the exact same EHR systems had differing patterns when it came to utilizing certain EHR features. The study followed 112 physicians and nurse practitioners who interacted with nearly 100,000 patients over the course of three and a half years.

The providers studied were all part of the Institute of Family Health network located in New York City and a few regions surrounding the city. The network includes 18 sites and took part in EHR integration 12 years ago. Approximately 50 percent of providers within this healthcare system met Stage 1 Meaningful Use in 2012.

Some of the EHR feature use analyzed under this study included the updating of patient problem lists, the interaction with clinical decision support tools and alerts, the sharing of after-visit summaries, and the incorporation of panel management options into regular use.

The study at hand was conducted in order to show how different organizations may customize, implement, and use EHR features in varying ways, which may be why the quality of care and patient safety contrasts across the country.

Some results from the study showed that, as the frequency of alerts increased, the response rates to decision-support alerts fell. To clarify, for every extra 100 alerts, physicians accepted one percent fewer than before. Additionally, responsiveness to decision-support alerts varied among physicians.

There was a significant amount of variability seen with the updating of problem lists. The yearly average rate of problem list updates ranged from 5 percent to 60 percent depending upon the provider.  Another trend that differed among doctors was the number of days needed to review laboratory test results. Between 2010 and 2012, there was also a slight increase in the number of patients participating in the patient portal.

Some of the other differences that researchers encountered include the providers’ behavior with new patients versus established ones. Additionally, response to common alerts varied from responses to new alert types.

Considering this type of variation could be an important task during EHR integration as well as when updating systems. These contrasts among physician EHR use could also impact the costs and quality of care associated with health IT. In addition, some Stage 1 Meaningful Use requirements may be too basic for providers such as illustrating that the decision support tools have been implemented; technically providers do not have to show they have accepted any alerts.

The researchers conclude that EHR systems will not reach their intended goal of improving healthcare quality if their features are not used regularly. Since providers incorporated personalized patterns of EHR use even at the same center, this variability could be valuable for further study on the quality outcomes of physician EHR use.

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