“CATCH-IT Reports” are Critically Appraised Topics in Communication, Health Informatics, and Technology, discussing recently published ehealth research. We hope these reports will draw attention to important work published in journals, provide a platform for discussion around results and methodological issues in eHealth research, and help to develop a framework for evidence-based eHealth. CATCH-IT Reports arise from “journal club” - like sessions founded in February 2003 by Gunther Eysenbach.

Tuesday, September 29, 2009

The Relationship between Electronic Health Record Use and Quality of Care over Time

Zhou L, Soran CS, Jenter CA, Volk LA, Orav EJ, Bates DW, Simon, SR. Relationship between EHR use and Quality of Care over Time. J Am Med Inform Assoc. Jul-Aug 2009;16:457– 464.

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Full-text article: http://www.jamia.org.myaccess.library.utoronto.ca/cgi/content/full/16/4/457
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Electronic health records (EHRs) have the potential to advance the quality of care, but recent studies have shown mixed results. We undertook the present study to examine the extent of EHR usage and how the quality of care delivered in ambulatory care practices varied according to duration of EHR availability.

We linked two data sources: a statewide survey of physicians' adoption and use of EHR and claims data reflecting quality of care as indicated by physicians' performance on widely used quality measures. Using four years of measurement, we combined 18 quality measures into 6 clinical condition categories. While the survey of physicians was cross-sectional, respondents indicated the year in which they adopted EHR. In an analysis accounting for duration of EHR use, we examined the relationship between EHR adoption and quality of care.

The percent of physicians reporting adoption of EHR and availability of EHR core functions more than doubled between 2000 and 2005. Among EHR users in 2005, the average duration of EHR use was 4.8 years. For all 6 clinical conditions, there was no difference in performance between EHR users and non-users. In addition, for these 6 clinical conditions, there was no consistent pattern between length of time using an EHR and physicians' performance on quality measures in both bivariate and multivariate analyses.

In this cross-sectional study, we found no association between duration of using an EHR and performance with respect to quality of care, although power was limited. Intensifying the use of key EHR features, such as clinical decision support, may be needed to realize quality improvement from EHRs. Future studies should examine the relationship between the extent to which physicians use key EHR functions and their performance on quality measures over time.