Variability in EHR use by individual practitioners 'high'

Physicians, even those within the same practice, use their electronic health record systems differently, which may affect differences in quality and cost outcomes, according to a new study in the Journal of the American Medical Informatics Association.

The researchers, from the Center for Healthcare Informatics and Policy at Weill Cornell Medical College and elsewhere, hypothesized that the effects of EHRs may depend in part on how they're used, not just on whether EHRs are available. They analyzed 430,803 encounters of 99,649 patients by 112 physicians and nurse practitioners in a network of federally qualified health centers in the New York City area.

They found that variability among practitioners was "high." The clinicians developed personalized approaches to EHR use, such as how often they updated patient problem lists, when they would respond to clinical decision support alerts and whether the encounter was with a new or established patient. Even Meaningful Use objective metrics, which are more likely to be standardized, varied.  

Other research has found that physicians do not give the same amount of attention to all EHR functions, with many spending more time in the "impression and plan" section of the electronic note but virtually ignoring medication lists. Personality and opinions about EHRs also affect the use and acceptance of such tools, according to research published in January in Perspectives in Health Information Management.

The JAMIA research revealed a number of reasons for the aforementioned variability, including a practitioner's familiarity with the EHR system, familiarity with the patient's condition being treated and staffing differences, which could affect workflow.

"EHRs, like other information technologies, cannot be expected to cause the intended effects on healthcare delivery unless their features are regularly used," the researchers said. "Primary care providers at a single center using the same EHR product varied in their use of available functions of the EHR. This suggests that individual level measures of usage may add value to future research on quality and cost outcomes of EHR use."

To learn more:
- read the abstract