TY - JOUR
T1 - Electronic health record use and the quality of ambulatory care in the United States
AU - Linder, Jeffrey A.
AU - Ma, Jun
AU - Bates, David W.
AU - Middleton, Blackford
AU - Stafford, Randall S.
N1 - Copyright:
Copyright 2009 Elsevier B.V., All rights reserved.
PY - 2007/7/9
Y1 - 2007/7/9
N2 - Background: Electronic health records (EHRs) have been proposed as a sustainable solution for improving the quality of medical care. We assessed the association between EHR use, as implemented, and the quality of ambulatory care in a nationally representative survey. Methods: We performed a retrospective, crosssectional analysis of visits in the 2003 and 2004 National Ambulatory Medical Care Survey. We examined EHR use throughout the United States and the association of EHR use with 17 ambulatory quality indicators. Performance on quality indicators was defined as the percentage of applicable visits in which patients received recommended care. Results: Electronic health records were used in 18% (95% confidence interval [CI], 15%-22%) of the estimated 1.8 billion ambulatory visits (95% CI, 1.7-2.0 billion) in the United States in 2003 and 2004. For 14 of the 17 quality indicators, there was no significant difference in performance between visits with vs without EHR use. Categories of these indicators included medical management of common diseases, recommended antibiotic prescribing, preventive counseling, screening tests, and avoiding potentially inappropriate medication prescribing in elderly patients. For 2 quality indicators, visits to medical practices using EHRs had significantly better performance: avoiding benzodiazepine use for patients with depression (91% vs 84%; P=.01) and avoiding routine urinalysis during general medical examinations (94% vs 91%; P=.003). For 1 quality indicator, visits to practices using EHRs had significantly worse quality: statin prescribing to patients with hypercholesterolemia (33% vs 47%; P=.01). Conclusion: As implemented, EHRs were not associated with better quality ambulatory care.
AB - Background: Electronic health records (EHRs) have been proposed as a sustainable solution for improving the quality of medical care. We assessed the association between EHR use, as implemented, and the quality of ambulatory care in a nationally representative survey. Methods: We performed a retrospective, crosssectional analysis of visits in the 2003 and 2004 National Ambulatory Medical Care Survey. We examined EHR use throughout the United States and the association of EHR use with 17 ambulatory quality indicators. Performance on quality indicators was defined as the percentage of applicable visits in which patients received recommended care. Results: Electronic health records were used in 18% (95% confidence interval [CI], 15%-22%) of the estimated 1.8 billion ambulatory visits (95% CI, 1.7-2.0 billion) in the United States in 2003 and 2004. For 14 of the 17 quality indicators, there was no significant difference in performance between visits with vs without EHR use. Categories of these indicators included medical management of common diseases, recommended antibiotic prescribing, preventive counseling, screening tests, and avoiding potentially inappropriate medication prescribing in elderly patients. For 2 quality indicators, visits to medical practices using EHRs had significantly better performance: avoiding benzodiazepine use for patients with depression (91% vs 84%; P=.01) and avoiding routine urinalysis during general medical examinations (94% vs 91%; P=.003). For 1 quality indicator, visits to practices using EHRs had significantly worse quality: statin prescribing to patients with hypercholesterolemia (33% vs 47%; P=.01). Conclusion: As implemented, EHRs were not associated with better quality ambulatory care.
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U2 - 10.1001/archinte.167.13.1400
DO - 10.1001/archinte.167.13.1400
M3 - Article
C2 - 17620534
AN - SCOPUS:34447329864
SN - 0003-9926
VL - 167
SP - 1400
EP - 1405
JO - Archives of Internal Medicine
JF - Archives of Internal Medicine
IS - 13
ER -