- Kenny Lin, MD
In an editorial in the May 15th issue of AFP, I summarized the mixed evidence that using electronic health records with clinical decision support systems (CDSSs) improves processes and outcomes of preventive care. Most of the literature supporting a positive effect of EHRs with CDSSs is either anecdotal, observational, or limited to specific settings (namely, practices of employed physicians in large, integrated health systems). I concluded that it remained uncertain if these results could be duplicated in randomized trials in typical private practices.
Uncertain, that is, until this week, following a study by Alex Krist and colleagues, "Interactive Preventive Health Record to Enhance Delivery of Recommended Care: A Randomized Trial," in the Annals of Family Medicine. The authors randomized 4500 patients from 8 primary care practices in Virginia to usual care versus an invitation to use MyPreventiveCare, an interactive personal health record (IPHR) that generates a list of screening and counseling recommendations based on guidelines from the U.S. Preventive Services Task Force, as well as links to more detailed explanations of these preventive services and relevant decision aids. When patients used the IPHR, their physicians also received a summary of the recommendations in their EHRs.
Although only about 1 in 6 invited patients had actually used the personal health record 16 months later, it was enough to show a statistically significant difference between the proportion of patients in that group who were up-to-date on all recommended services, compared to the control group. After 4 months, colorectal, breast, and cervical cancer screening rates had increased by an impressive 13 to 19 percent among personal health record users. The authors concluded: "Information systems that feature patient-centered functionality, such as the IPHR, have potential to increase preventive service delivery. Engaging more patients to use systems could have important public health benefits." A how-to guide on the use of personal health records to promote preventive services is available on the Agency for Healthcare Research and Quality website.
Wednesday, July 11, 2012
Subscribe to:
Post Comments (Atom)
NOT surprising that preventive services are increased by EHRs - since this type of information is so much more easily tracked once it is entered. That said - I must admit I'm skeptical of what to do with any of this data ....
ReplyDeleteClearly - EHR facilitates tracking of information ONCE the information is entered into a system that providers are comfortable and time-efficient with. That said - a HUGE investment of time and effort is needed to initially enter the data (eliminating paper charts along the way) and get to that "comfort point". Once one arrives at that point - there are many who love the result and can't imagine how it used to be during the "old days" of paper charting. Others never "arrive" or aren't so enthralled ...
I think implementation of EHR is a highly individualistic enterprise - with success determined by the providers involved (all in one's system have to "buy into it") and the particularities of each system. In my opinion - I just don't think this is something that can ever be "proved" by any study ... (which is subject to the whim & bias of the investigators in terms of how results are "spun").
Let me emphasize that I'm NOT against EHR - and fully believe that certain systems in certain settings have a tremendous amount to offer. I'm simply saying that I'm highly skeptical that the "value" of EHR can be "proved" by scientific study ...