U.K. researchers pinpoint gaps in literature on electronic records

A clear understanding of the electronic health record and its likely impact on costs and clinical and administrative workflow and behavior remains elusive, according to U.K. researchers.

Dr. Susan Clamp of the Yorkshire Centre for Health Informatics and Prof. Justin Keen of the University of Leeds conducted an in-depth literature review on the effects of EHRs and the implications for practitioners and policy makers. They presented their findings at the World of Health IT Conference and Exhibition held Oct. 10 to 13 in Geneva.

"Electronic records are at the heart of a healthcare IT implementation. Policy documents tend to be full of aspirational statements but not realistic goals," Clamp said. "EHRs can have a direct impact on behavior and can influence processes, especially communication patterns and quality, but no studies capture the macro effects of costs and effects, as well as the economies of scope and scale."

The researchers identified over 300 papers, including 70 key articles. They found that the literature contains good experimental evidence, but this focuses on processes and not patient outcomes or costs. There are some well-designed survey data, narrative observational studies, and predictive modeling of cost savings but few economic evaluations and very limited empirical evidence.

Authors tend to make strong claims about cost savings resulting from electronic records, but the evidence is relatively weak, Clamp said.

"There is a need for a more sophisticated approach to evaluate the technology used by many types of clinicians at different points in time and space and to provide evidence of impact along care pathways," she said. "Research designs must reflect this to capture the benefits that will come through the interoperability of systems."

Clamp thinks researchers should include PACS and other imaging modalities in the analysis on an EHR because they include important clinical data. Reasonable evidence suggests positive changes can occur in radiology departments, but not in terms of diagnostic accuracy.

Authors assume that an EHR influences behavior; for instance, by improving communication between clinicians. But no studies are designed to capture this or the costs and benefits and none provide adequate contextual information, she said.

The Geneva congress was organized by the Health Information and Management Systems Society, the European Commission, and the World Health Organization. The event attracted about 1700 attendees and 60 exhibitors. A follow-up event will be held in Vienna in late October 2007.

For more information from the Diagnostic Imaging archives:

Making sense of digital imaging's alphabet soup

PACS forges connection to electronic health record

Quest for integration dominates meeting

In 2006, has the EHR's time finally come?