Electronic Health Records Linked To Only Slightly Better Medical Care

Jonathan R. Enriquez, MD Assistant Professor of Medicine Division of Cardiology University of Missouri- Kansas City Director, Coronary Care Unit Truman Medical Center

Dr. Enriquez

MedicalResearch.com Interview with:
Jonathan R. Enriquez, MD
Assistant Professor of Medicine
Division of Cardiology
University of Missouri- Kansas City
Director, Coronary Care Unit
Truman Medical Center 

Medical Research: What is the background for this study?

Dr. Enriquez:  

  • In 2009, U.S. legislation appropriated tens of billions of dollars to promote the use of electronic health records (EHRs).
  • Approximately 4 million hospitalizations for cardiovascular diagnoses occur annually in the U.S., which are more hospitalizations than for any other category of disease.  Therefore, evaluating the use of EHRs in these settings can help us understand how to best optimize the care and outcomes of a huge set of patients.

Medical Research: What are the main findings?

Dr. Enriquez:

  • In our study which included over 120,000 patients from more than 400 hospitals in the National Cardiovascular Data Registry, over 80% of hospitals implemented EHRs by 2007. In 2010, almost all hospitals (>99%) were using EHRs in some form.
  • EHR use was associated with less heparin overdosing and slightly greater adherence to acute myocardial infarction guideline-recommended therapies.
  • In non–ST-segment–elevation myocardial infarction, slightly lower adjusted risk of major bleeding and mortality was seen in patients from hospitals with full EHRs; however, in ST-segment–elevation myocardial infarction, differences in outcomes were not seen.

Medical Research: What should clinicians and patients take away from your report?

Dr. Enriquez: We observed slightly better care and modestly lower risk of adverse outcomes in some subsets of patients with acute MI, but no significant differences in others. With $19 billion dollars appropriated by HITECH to promote EHR use, it seems reasonable to strive for more clinically meaningful and consistent gains from that investment. Since EHRs are likely here to stay, the question moving forward should be, “How can this technology be more effectively leveraged to create more consistent gains in quality and outcomes?”

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Enriquez: Additional rigorous evaluation of EHRs is still needed to determine which facets of EHR use are most beneficial for patients and providers, and which aspects are hindrances and in need of further improvements.

Citation:

Modest Associations Between Electronic Health Record Use and Acute Myocardial Infarction Quality of Care and Outcomes: Results From the National Cardiovascular Data Registry

Jonathan R. Enriquez, James A. de Lemos, Shailja V. Parikh, DaJuanicia N. Simon, Laine E. Thomas, Tracy Y. Wang, Paul S. Chan, John A. Spertus, And Sandeep R. Das

Circ Cardiovasc Qual Outcomes.2015;CIRCOUTCOMES.115.001837published online before print October 20 2015, doi:10.1161/CIRCOUTCOMES.115.00183

Jonathan R. Enriquez, MD (2015). Electronic Health Records Linked To Only Slightly Better Medical Care 

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