A study published in Circulation: Cardiovascular Quality and Outcomes analyzed the link between electronic health record (EHR) use with quality of care and outcomes after acute myocardial infarction (MI). In a Q&A with Physician’s Weekly, lead author Jonathan Enriquez, MD, offered his insights on the key findings as well as the implications of this research.
Q: What is the background for this study?
A: In 2009, legislation in the United States appropriated tens of billions of dollars to promote the use of EHRs. Each year, there are approximately 4 million hospitalizations involving cardiovascular diagnoses in the U.S. There are more hospitalizations for cardiovascular diagnoses than for any other disease category. Therefore, evaluating the use of EHRs in these settings can help physicians understand how to best optimize the care and outcomes of an enormous set of patients.
Q: What are the main findings that emerged from the study?
A: Our study included over 120,000 patients from more than 400 hospitals in the National Cardiovascular Data Registry. Over 80% of hospitals implemented EHRs by 2007, but by 2010, almost all hospitals (>99%) were using EHRs in some form.
EHR use was associated with less heparin overdosing and slightly greater adherence to acute MI guideline-recommended therapies. In non–ST-segment–elevation MI, slightly lower adjusted risk of major bleeding and mortality was seen in patients from hospitals with full EHRs. However, differences in outcomes were not seen in ST-segment–elevation MI.
Q: What should clinicians and patients take away from your study?
A: We observed slightly better care and modestly lower risk of adverse outcomes in some subsets of patients with acute MI, but no significant differences in others. The Health Information Technology for Economic and Clinical Health (HITECH) Act has appropriated approximately $19 billion dollars by to promote EHR use. Considering the significance of the HITECH Act, it seems reasonable to strive for more clinically meaningful and consistent gains from that investment. Since EHRs are likely here to stay, the question moving forward should be how this technology can be more effectively leveraged to create more consistent gains in quality and outcomes.
Q: What recommendations do you have for future research as a result of this study?
A: Additional rigorous evaluation of EHRs is still needed to determine which facets of EHR use are most beneficial for patients and providers. We also need to conduct studies that explore specific aspects that may be hindrances and identify areas in which we need further improvement.
Readings & Resources (click to view)
Enriquez JR, de Lemos JA, Parikh SV, et al. Modest associations between electronic health record use and acute myocardial infarction quality of care and outcomes: results from the National Cardiovascular Data Registry. Circ Cardiovasc Qual Outcomes. 2015 Oct 20 [Epub ahead of print]. Available at: http://circoutcomes.ahajournals.org/content/early/2015/10/20/CIRCOUTCOMES.115.001837.abstract.
Appari A, Eric Johnson M, Anthony DL. Meaningful use of electronic health record systems and process quality of care: evidence from a panel data analysis of U.S. acute-care hospitals. Health Serv Res. 2013;48:354-375.
Peterson ED, Roe MT, Rumsfeld JS, et al. A call to ACTION (acute coronary treatment and intervention outcomes network): a national effort to promote timely clinical feedback and support continuous quality improvement for acute myocardial infarction. Circ Cardiovasc Qual Outcomes. 2009;2:491-499.
Roe MT. Success stories: how hospitals are improving care. Am Heart J. 2004;148(suppl):S52-S55.