eHealth News: Review of Evidence for Electronic Medical Records

4434872615_95e316538eA lot of hope is being placed on the ability of electronic medical records (EMR) to bail the US out of the health care mess it finds itself in. They are supposed to improve efficiency, lower cost, improve outcomes. To that end, some $30 billion in federal funding is backing its development and widespread implementation, despite a lack of clarity as to what health benefits EMR are supposed to deliver, and whether there’s evidence to support these abilities.

Now researchers in the UK have completed a major review of the evidence supporting EMR and several other forms of ehealth. Their review was just published in the online journal PLoS Medicine. After trolling through some 43,000 citations with a fine toothed comb, reviewers  applied strict inclusion criteria that netted 53 published reviews to analyze. Another 55 reviews provided additional context and helped with interpretation.

Their findings:

--Evidence that EMR will provide expected benefits is “Weak and inconsistent.”

--As for cost effectiveness? There’s “virtually no evidence” to support them.

--On EMR: “We found only anecdotal evidence of the fundamental expected benefits and risks relating to the organisational efficiency”

--On computerized order entry: “findings from these reviews indicated weak evidence of an impact on organisational efficiency.”

--And with ePrescribing they found “far less evidence for improvements in patient level outcomes as even in the case of medication errors, it was unclear what proportion of these actually resulted in patient harm.” It sped things up to a certain extent, but resulted in less information-rich communication among providers.

In fairness to the world of e-Health, the recent launch of Dartmouth’s Master of Health Care Delivery Science program provided a example of one slam-dunk application. The first lecture and educational module in this hybrid online-onground masters degree program covered process analysis. Process analysis provides mathematical models for measuring, mapping, and as the name implies, analyzing process. It lets you find bottlenecks, measure through-put, assess the true capacity of a system, and aids in redesign. If, as most health care policy makers assert, health reform requires extensive redesign, then process analysis is fundamental. Where does the electronic records piece fit in?

To analyze a process you need to measure how something passes through the process, be  it a person, a piece of information, a lab specimen, or whatever. Traditionally this means sitting someplace with a pencil and stop watch. Of course with health care, its not always that simple. Getting an x-ray? First you speak with a receptionist, sit in the waiting room, get changed into a gown, go to the imaging room, get dressed again, wait for the clinician to review your image, then go speak with your doctor. All of that may involve different buildings, and the guy with the pencil and stopwatch is certainly not invited to tag along.

That’s where something as simple as time stamps on electronic communications and records is invaluable. In fact, if time and location were integral parts of all electronic record keeping, then there’s no reason that health care systems couldn’t be constantly analyzing their processes to identify bottlenecks and efficiency, not to mention provide a snapshot of the time and logistical hurdles that patients face. (The goal of health care, is after all, to provide for better patient health and experience.)

eHealth and EMR will no doubt push forward, regardless of the evidence that they may not help much, or a lack of evidence that they will help. The future of health is digital. Is this grand experiment worth $30 billion in borrowed federal money? Is the potential for greater efficiency that tech-enabled process analysis has to offer worth the investment?

What do you think?

(In the interests of full disclosure: This author is an Instructional Designer for Dartmouth’s Master of Health Care Delivery Science Program.)