Paper practices beat EHRs in outcomes, treatment adherence

The use of electronic health records (EHRs) does not guarantee a higher quality of care, just a higher quality of reporting, according to a meta-analysis of articles published in the Journal of Diabetes Science and Technology.

Researchers, led by Stephanie E. Lessing, MS, of the University of Massachusetts Boston, sought to identify the existing strengths and limitations of EHRs within patient care. Additionally, they assessed future opportunities for improvement suggested in original research and recent systematic reviews.

Other studies have shown EHRs have been linked to physician burnout, and many providers struggle with adopting the technology in everyday practice. 

For their analysis, the authors assessed original research that was published between March 2003 and November 2017. Specifically, they included randomized controlled trials that comprised of patients who were 18 or older with a diabetes diagnosis.

The measured outcomes included HbA1c, blood pressure readings and LOL cholesterol levels. The research also focused on EHR outcomes, the patients’ improvement of care, adverse outcome prevention, web-based communication and the limitations of EHRs regarding chronic disease management.

Upon analysis of 13 studies, Lessing et al. found paper-based practices performed better with respect to adherence to process and treatment guidelines and intermediate outcomes, compared with practices that utilize EHR systems. They also noted the integration of EHR systems within medical practices takes more than a year, and the process should be “strengthened” in earlier integration stages. 

“This systematic review reveals that EHR has progressed substantially in providing benefits to both patients and practitioners,” Lessing et al. concluded. 

Patients with chronic diseases benefit the most by decision support tools that alert physicians of drug interactions, communication tools that keep them informed and participating in treatments, and detailed reporting and tracking that informs progress without over-testing. 

Decision support tools within EHR might be useful in increasing provider adherence to processes and guidelines through the use of reminders for tests or follow up questions and treatment modifications, the reviewers wrote. EHRs have progressed substantially in providing benefits to both patients and practitioners.

“As EHR technology continues to improve, it is likely that the treatment outcomes of chronic disease patients will also improve considerably,” the authors wrote.

Still, there is “expansive space” for further research in EHR usage, including how they can be better utilized for new drug and treatment options for chronic disease, patient portals and daily diaries.

“As new opportunities for further development are being explored, the design of new features should be tested using randomized studies to strengthen researchers’ understanding of effects with a more representative method,” Lessing et al. wrote.