Spin on the study that says ambulatory EHRs don't improve health care

Here's the scoop, from Archives of Internal Medicine, via Reuters/Yahoo, via iHealthbeat:

The study found that EHRs did not affect 14 of 17 quality measurements evaluated. In two of the areas, better quality was associated with EHRs, while in one area, worse quality was associated with EHRs, according to researchers at Stanford University and Harvard University.

The study was based on a survey of 1.8 billion physician visits in 2003 and 2004, 18% of which used EHRs.

"Our findings were a bit of a surprise. We did expect practices [with EHRs] would have better quality of care," Randall Stafford of Stanford, said, adding, "They really performed about the same."

The story ends there for most folks.

However, the WSJ Health Blog guys, being either more thorough or more easily duped (I'd guess the former), conclude with the study's authors' observations that correlation doesn't equal causality, more study is needed, the data is old, EHR systems implemented since the time the studied data was collected are oh-so-better, there's room for improvement, etc.

The value of system-wide implementation of EHRs may ultimately be at the system level, not at the patient level -- the ability to identify and implement best practices based on massive quantities of data seems likely to "lift all boats," as it were.  The study focused on indicators physicians already knew aboout; perhaps the key value in EHRs in improving population-wide health will be the ability to identify new indicators. The question remains: how does this technological imperative get funded at the individual practice level if the benefit is at the system level? 

(See past HealthBlawg posts on EHRs.)

-- David Harlow