The relationship between electronic health record use and quality of care over time

Abstract

OBJECTIVE Electronic health records (EHRs) have the potential to advance the quality of care, but studies have shown mixed results. The authors sought to examine the extent of EHR usage and how the quality of care delivered in ambulatory care practices varied according to duration of EHR availability. METHODS The study linked two data sources: a statewide survey of physicians' adoption and use of EHR and claims data reflecting quality of care as indicated by physicians' performance on widely used quality measures. Using four years of measurement, we combined 18 quality measures into 6 clinical condition categories. While the survey of physicians was cross-sectional, respondents indicated the year in which they adopted EHR. In an analysis accounting for duration of EHR use, we examined the relationship between EHR adoption and quality of care. RESULTS The percent of physicians reporting adoption of EHR and availability of EHR core functions more than doubled between 2000 and 2005. Among EHR users in 2005, the average duration of EHR use was 4.8 years. For all 6 clinical conditions, there was no difference in performance between EHR users and non-users. In addition, for these 6 clinical conditions, there was no consistent pattern between length of time using an EHR and physicians performance on quality measures in both bivariate and multivariate analyses. CONCLUSIONS In this cross-sectional study, we found no association between duration of using an EHR and performance with respect to quality of care, although power was limited. Intensifying the use of key EHR features, such as clinical decision support, may be needed to realize quality improvement from EHRs. Future studies should examine the relationship between the extent to which physicians use key EHR functions and their performance on quality measures over time.

Figure 1

Among Physicians with EHRs, Availability and Usage of EHR Core Functions over Time. The length of each bar indicates the percentage of physicians who have each function available in their system. The component segments of each bar reflect the percentage of physicians using each function most or all of the time, some of the time, or not at all.

Figure 2

A–F. display the adjusted averages of HEDIS® measure rates by the duration of EHR use for each of the six clinical conditions. The X axis indicates the years of using an EHR. “0” indicates the year of beginning implementing an EHR. Multivariate regression models shows there was no association between duration of using an EHR and physicians' performance for each group of HEDIS® quality measures. ▶A. Cancer Screening. ▶B. Diabetes Care. ▶C. Asthma Care. ▶D. Well Child and Adolescent Visit (Only included respondents who practice in pediatrics and family medicine). ▶E. Behavioral and Mental Health. ▶F. Women's Health.