EMR improves quality of healthcare

Quality of care for patients of the Veterans Health Administration (VHA) improved following the introduction of an integrated electronic medical record (EMR), performance measurement, and other system changes, according to a new Veterans Affairs study.

"We found that at the VA, patients were getting two-thirds of recommended care," said Dr. Steven M. Asch, an associate professor in residency at the VA Greater Los Angeles Healthcare System and David Geffen School of Medicine at the University of California, Los Angeles. "That's significantly higher than what patients in the rest of the country receive, which is just half of recommended care."

Researchers investigated the effect of sweeping changes such as the introduction of an EMR on the quality of care (Ann Intern Med 2004;141(12):938-945). In 2003, this same research team had demonstrated that U.S. adults were receiving recommended care about half of the time.

"We wanted to look at the VA, because the VA has instituted many of the reforms the Institute of Medicine suggested would improve quality of care," Asch said.

The team used chart review methods and data collectors to compare VA quality of care with that received by similar patients throughout the country. The findings demonstrate that it is possible to improve patient care, he said.

Asch and colleagues measured quality at 12 VHA healthcare systems and 12 community systems between 1997 and 2000 using a chart-based quality instrument consisting of 348 indicators targeting 26 conditions. The VHA scored significantly higher than a national sample for adjusted overall quality (67% versus 51%), chronic disease care (72% versus 59%), and preventive care (64% versus 44%).

"This is further evidence of how important information technology is to improving care, particularly in areas like diagnostic imaging where availability of images and results are so important," Asch said. "It also challenges us to actively pursue information technology and performance measurement systems to improve care for our patients."

He said most healthcare leaders recognize the need to wire today's healthcare system for the 21st century. But embracing information technology alone isn't enough - tracking performance is also key. It's like checking a consumer product's reliability and durability before purchase.

"In healthcare, we're looking for ways to do the same thing," he said. "This study provides evidence that tracking performance improves performance."