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Electronic Health Record Use and the Quality of Ambulatory Care in the United States
Jeffrey A. Linder, MD, MPH;
Jun Ma, MD, RD, PhD;
David W. Bates, MD, MSc;
Blackford Middleton, MD, MPH, MSc;
Randall S. Stafford, MD, PhD
Arch Intern Med. 2007;167(13):1400-1405.
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, cross-sectional 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.
Author Affiliations: Division of General Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts (Drs Linder, Bates, and Middleton); and Program on Prevention Outcomes and Practices, Stanford Prevention Research Center, Stanford University, Stanford, California (Drs Ma and Stafford). Dr Ma is now with the Department of Health Services Research, Palo Alto Medical Foundation Research Institute, Palo Alto, California.
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