Researchers: EHR outcome, MU studies need to shift focus

Clinical decision support tools and computerized physician order entry--both Meaningful Use program requirements--are proven to have positive effects on quality outcomes, but reporting of contextual and implementation details have been "poor," making it impossible to determine why some electronic health record implementations were successful and some not, according to a new study funded by the Office of the National Coordinator for Health IT published in the Annals of Internal Medicine.

The researchers, from the RAND Corporation, reviewed 236 studies assessing EHRs and outcomes with an eye on the Meaningful Use requirements. Fifty-six percent of the studies focused on CDS and CPOE, and most reported a positive or mixed positive result.   

"Healthcare providers should be encouraged to adopt CDS and CPOE, and future studies of CDS and CPOE should concentrate on how to make them work better rather than testing the hypothesis of whether they work at all," the researchers said.

However, almost half (12 of 25) of the Meaningful Use requirements--such as "maintain medication allergy lists" or "capacity to track vital signs"--weren't evaluated in any studies, despite the fact that they are critical to functionality. The researchers recommended that evaluations of EHRs and Meaningful Use evolve.

"Stakeholders with interests in health IT ... can help researchers shift their focus from if to how by promoting, soliciting, and publishing research that empirically studies the mediating effects of contextual and implementation factors on the relationship between health IT and key healthcare outcomes," the researchers said. "Such a shift in focus will greatly advance the science of health IT evaluation and greatly increase our understanding of how the positive effects of health IT can be maximized and negative effects can be avoided or remediated."

A blog post on the study by ONC's Michael Furukawa and Meghan Gabriel touted the "strong evidence that health IT improves patient outcomes" while downplaying the study's other findings.

EHRs continue to prove their potential worth in research and outcomes. Further refinement of the data stored in EHRs and the studies themselves will improve this research and the resulting patient care even further.

To learn more:
- read the study
- here's the blog post