Debate over EHR value in patient care misses key point

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As more and more physicians adopt electronic health records, the debate over whether electronic health records actually improve the quality of care has risen to a new crescendo. Yet the discussion is not shedding much light on the key issues.


In the latest tit for tat, a new study in the Annals of Family Medicine found that type 2 diabetes patients in practices using paper records achieved better intermediate outcomes than did patients in practices with EHRs. In contrast, a recent paper in the New England Journal of Medicine showed that EHR-based practices provided better treatment and produced better outcomes for diabetes patients than did paper-based practices. And a paper presented at the recent American Association of Clinical Endocrinology meeting found that the use of an insulin order set in a hospital EHR improved glycemic control for hospitalized patients with diabetes.


These studies are not strictly comparable. The first two were based on ambulatory care, whereas the third looked at inpatient care. Also, the AFM study used a far smaller sample than the NEJM study did and examined data from 2004-2006, while the NEJM dataset was from 2009-2010. And the EHR-based practices in the AFM study were using inadequate or no decision support tools, while those profiled in the NEJM paper had relatively good decision support.

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