Despite Drawbacks and Frustration, EHRs Could Have Meaningful Benefit in Acute MI Patients
Designed ostensibly to improve efficiency and improved outcomes, electronic health records (EHRs) have often been criticized by physicians as being both frustrating and costly to implement. Now a new study hints that their use might tangibly benefit patients with acute MI.
“We found that EHR use may be associated with some aspects of higher quality [acute MI] care, such as less heparin overdosing and more frequent receipt of evidence-based therapies; however, these findings may not reliably translate into a lower risk of adverse events across all subtypes of MI and outcomes measured,” according to Jonathan R. Enriquez, MD, of the University of Missouri, Kansas City, and colleagues.
The findings were published online October 20, 2015, ahead of print in Circulation: Cardiovascular Quality and Outcomes.
The 2009 HITECH Act appropriated funding to encourage the use of EHRs in the United States, despite a lack of consensus over whether the systems actually improve healthcare outcomes. TCTMD reported last year that providers who did not demonstrate “meaningful use” of EHRs before the first day of 2015 would be subject to an annual, cumulative reimbursement penalty from CMS for each year they remain noncompliant.
More Defect-Free Care
Using information from both the ACTION Registry-Get With The Guidelines database and the American Hospital Association annual survey, investigators studied 124,826 patients admitted to 414 US hospitals with MI between 2007 and 2010. Overall EHR implementation—full and partial—increased from 82.1% to 99.3% over the study period.
The degree to which hospitals had adopted EHRs did not lead to clinically meaningful differences in whether patients received guideline-based medical therapy within the first 24 hours or at discharge. However, unfractionated heparin was more likely to be given to patients treated at hospitals with EHRs (either full or partial use) than those without. Also, fewer overdosing errors for unfractionated heparin, both bolus and infusion, were reported among hospitals fully using EHRs compared with those either partially adopting the practice or not having EHRs at all (all P < .01 for trend).
Notably, patients treated at hospitals with either partially (adjusted OR 1.49; 95% CI 1.20-1.84) or fully implemented EHR use (adjusted OR 1.40; 95% CI 1.07-1.84) were more likely to receive defect-free care—a metric that captured whether guideline recommendations were followed—compared with patients treated at facilities with no EHR system in place.
Among NSTEMI patients, hospitals’ level of EHR use was associated with lower risks of both major bleeding and mortality (table 1). However, there were no such differences seen within the STEMI population.
At the hospital level, there was a mean 12.1% increase in guideline-recommended care from 1 year before EHR adoption to 1 year after for facilities with both partial and full implementation practices. By comparison, hospitals that did not adopt EHRs only had a mean 5.8% increase in this metric.
‘Likely Here to Stay’
Enriquez told TCTMD that, because cardiovascular reasons account for more hospitalizations in the United States than any other category of disease, “evaluating the use of EHRs in these settings can help us understand how to best optimize the care and outcomes of a huge set of patients.”
Whether or not physicians like—or even tolerate—EHRs, “they’re pretty much everywhere by now,” Enriquez said in an email. “Since EHRs are likely here to stay, the question moving forward should be: How can this technology be more effectively leveraged to create more consistent gains in quality and outcomes?”
Referring to the $19 billion appropriated through HITECH to promote EHR use, Enriquez conceded that “it seems reasonable to strive for more clinically meaningful and consistent gains from that investment.”
Heading into this new era of medicine, EHR use must be rigorously evaluated to understand which facets are most valuable for patients and providers as well as “which aspects are hindrances and in need of further improvements,” he said.
Enriquez JR, de Lemos JA, Parikh SV, et al. Modest associations between electronic health record use and acute myocardial infarction quality of care and outcomes: results from the National Cardiovascular Data Registry. Circ Cardiovasc Qual Outcomes. 2015;Epub ahead of print.
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- The Acute Coronary Treatment and Interventions Outcomes Network Registry-Get With The Guidelines is an initiative of the American College of Cardiology Foundation and the American Heart Association with partnering support from the Society of Chest Pain Centers, the American College of Emergency Physicians, and the Society of Hospital Medicine.
- Enriquez reports no relevant conflicts of interest.