Electronic medical records and pay for performance don’t improve care

Electronic medical records and pay for performance are among the ways health reformers are going to improve patient care.

It’s a fundamental shift in how doctors practice, with more practices adopting expensive EMRs. And with the advent of Accountable Care Organizations, doctors will soon be compensated in part by quality measures.

But will they work? Well, the jury’s still out.

Two articles caught my eye recently.

The first, from the WSJ’s Health Blog, reports on a study from the Archives of Internal Medicine:

[The study looked] at data from outpatient medical visits at nonfederal offices and hospitals between 2005 and 2007 to see how electronic health records correlated with 20 quality indicators. The findings are pretty stark: there was “no consistent association between” better quality of care and electronic medical records or a specific IT tool, clinical decision support.

In fact, EMRs were associated with significantly improved performance in only one measure — giving diet advice to high-risk adults. They didn’t improve performance in things including giving aspirin for coronary artery disease, depression treatment or blood-pressure measurement.

Considering how much money is being poured into the digitization efforts, it’s remarkable that it’s based on so little clinical efficacy. Don’t get me wrong, there’s no question that we should modernize antiquated paper and pen charts, but doing so under the guise of improving patient care is somewhat misleading at this point.

Also notable is the hit pay for performance took in a recent New York Times piece.

The BMJ looked at the NHS, which stuffed general practitioners’ mouths with proverbial gold by offering generous pay for performance incentives. So much so that the average GP in the NHS makes about $175,000 annually (110,000 pounds).

But there’s shockingly little to show for it:

“Pay for performance had no discernible effects on processes of care or on hypertension-related clinical outcomes,” the authors concluded. “Generous financial incentives, as designed in the U.K. pay-for-performance policy, may not be sufficient to improve quality of care and outcomes for hypertension and other common chronic conditions.”

Stephen B. Soumerai, a health policy researcher at Harvard who is also one of the study’s authors, says policy makers should try to evaluate the evidence before they invest substantial sums of money in quality improvement programs that may not work.

Yikes. Considering that every new model, ranging from Accountable Care Organizations to Medical Homes, feature quality incentives, that’s not encouraging.

Again, I’m not saying that doctors should continue to be paid by quantity as they are now. But health reformers need to be careful about overstating the benefits of such reforms to patients. The data isn’t there yet.

 is an internal medicine physician and on the Board of Contributors at USA Today.  He is founder and editor of KevinMD.com, also on FacebookTwitterGoogle+, and LinkedIn.

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