May 05, 2015
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Electronic health records not associated with better outcomes in stroke care

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Electronic health records were not associated with higher-quality care or better clinical outcomes for stroke care in a study of hospitals in the Get With the Guidelines–Stroke program.

Researchers compared whether hospitals with electronic health records (EHRs) differed in quality or outcome measures of ischemic stroke care vs. hospitals without EHRs.

They studied 626,473 patients from 1,236 U.S. hospitals participating in the Get With the Guidelines–Stroke program between 2007 and 2010. By the end of the study period, 511 hospitals had EHRs. Hospitals with EHRs were larger and more likely to be teaching hospitals or stroke centers than hospitals without EHRs, according to the researchers.

The quality outcome of interest was a composite measure requiring that a patient receive each achievement measure for which he or she was eligible (“all or none” care). The main clinical outcomes of interest were length of stay of longer than 4 days, discharge home and in-hospital mortality.

The researchers found no difference between hospitals with or without EHRs in patient odds of receiving “all or none” care (OR = 1.03; 95% CI, 0.99-1.06), of discharge home (OR = 1.02; 95% CI, 0.99-1.04) or of in-hospital mortality (OR = 1.01; 95% CI, 0.96-1.05).

However, they found that patient odds of having a length of stay of more than 4 days was slightly lower at hospitals with EHRs (OR = 0.97; 95% CI, 0.95-0.99).

Karen E. Joynt, MD, MPH

Karen E. Joynt

“EHRs do not appear to be sufficient, at least as currently implemented, to improve overall quality of care or outcomes for this important disease state,” Karen E. Joynt, MD, MPH, cardiologist at Brigham & Women’s Hospital and Harvard Medical School, said in a press release.

In a related editorial, John R. Windle, MD, and Thomas A. Windle, BA, both from the University of Nebraska Medical Center in Omaha, wrote that the study documents that the hospitals in the Get With the Guidelines–Stroke program are demonstrating higher levels of quality and better clinical outcomes, but that “these changes are due to guideline compliance, not simply to better documentation.”

If EHRs are to facilitate better clinical outcomes, then they must be designed with that as the first priority, they wrote. “We have known for some time that administrative data are a poor substitute for clinical documentation. An EHR’s first priority must be support of clinical care, not documentation for billing and reimbursement that adds a burden translatable into neither patient health nor safety.” – by Erik Swain

Disclosures: Joynt, John Windle and Thomas Windle report no relevant financial disclosures. Please see the full study for a list of all other researchers’ relevant financial disclosures.