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Advanced EHR Capabilities Lead to Improved Clinical Performance

The number of EHR super-user providers increased by 10 percent over a three-year period.

Between 2014 and 2017, healthcare facilities with more significant EHR capabilities had better clinical quality composite measures than other facilities, but healthcare clinics that adopted EHRs during that time period had less significant clinical quality increases, according to a study published in JAMA Network Open.

The latter finding might suggest a longer timeline for seeing clinical quality performance improvements after EHR adoption and implementation.

For over 15 years, healthcare stakeholders have considered the EHR to be vital in achieving quality patient care because of the data storage and analytic capabilities vastly exceeded other alternatives, such as paper records. EHRs also allow for optimization and tool integration to improve quality, such as clinical decision support and registries.

However, a gap remains between high-quality patient care and actual care delivery.

Researchers surveyed 1,141 ambulatory clinics in Minnesota, Washington, and Wisconsin from 2014 to 2017 to gather data on EHR capabilities and dissect clinical quality performance.

Researchers grouped 50 EHR capabilities into seven categories: no functional EHR, EHR under-user, EHR, neither under-user or super-user, EHR super-user, and a standardized composite of ambulatory clinical performance measures, the study authors explained.

In 2014, 51 percent of respondent clinics were EHR super-user and this percentage increased to 54 percent in 2015, 58 percent in 2016, and 61 percent in 2017.

The research revealed ambulatory clinics with more advanced EHR capabilities had higher scores on a composite measure of ambulatory clinical quality than other clinics. This result translated to a roughly 9 percent difference in the clinic’s rank in clinical quality.

The smaller number of clinics that gained advanced EHR capabilities over the three years improved more than other clinics, but the results were not statistically significant.

“This study suggests that ambulatory clinics with advanced EHR capabilities were associated with a better performance on a composite measure of ambulatory clinical quality than clinics with less-advanced EHR capabilities; clinics that adopted advanced EHR capabilities during a 3-year period were not associated with significant increases in ambulatory clinical quality performance,” wrote the study authors.

On average, EHR super-user clinics consistently had better clinical quality performance than clinics that were not super-users, but these results are compatible with either more significant impacts or empty impacts.

Additionally, over time, all clinic respondents improved clinical quality and clinics that transitioned to EHR super-user status had more notable increases in quality than did clinics with static EHR user status.

Although individual performance measure differences might have been small, researchers aggregated the small improvements over 13 measures. The net difference could be more clinically important, the study authors wrote.

For example, a small change in a clinical composite measure is equal to a change in 45 to 75 rank order places if the provider started near the top end of the rank order, or even 85 to 95 places if started in the middle of the rank order.

“These results are consistent with several hypotheses, including that increasing EHR capability is associated with no or, at best, modest improvements in clinical quality; improvements in clinical quality associated with increasing EHR capabilities take several years to be realized,” the study authors concluded.

“Over 2 to 3 years, the largest clinical quality increase was in clinics that already have a functioning EHR that is being underused in terms or its capabilities. As US health care continues to evolve and clinicians gain more EHR capabilities, our results and future studies of the new hypotheses generated will be vital to efforts to improve ambulatory clinical quality.”

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