EMRs don't guarantee quality care, a review of 50,000 patient records shows

On 14 of 17 measures, physicians using paper records did equally well as those using EMRs. They even outperformed electronic record users in one area.

By Kevin B. O'Reilly, AMNews staff. Aug. 13, 2007.

Physician offices using electronic medical records systems and doctors still stuck on pen and paper deliver about the same quality of care, according to a major retrospective study released last month.

The study, in the July 9 Archives of Internal Medicine, is based on data collected in 2003 and 2004 as part of the Centers for Disease Control and Prevention's National Ambulatory Care Survey. Examining more than 50,000 patient records from more than 2,500 physician offices, researchers found no statistically significant difference between EMR practices and non-EMR practices on 14 of 17 guideline-based quality metrics.

Physicians using EMRs were less likely to order unnecessary, routine urinalyses or inappropriately prescribe benzodiazepines to treat depression. Researchers described the differences, though, as "clinically insignificant," because the adherence to guidelines was so near 100%. Pen-and-paper doctors were 14 percentage points more likely than their tech-savvy counterparts to prescribe statins appropriately for patients with high cholesterol.

The published findings surprised researchers.

"We are all fans of electronic health records," said lead author Jeffrey A. Linder, MD, MPH, describing the study's five co-authors. "We'd hoped that there would be some association with electronic health records and quality. It turns out we didn't find any."

The news comes amid increasing pressure on physicians from the government and insurers to implement EMRs to cut costs and improve quality and patient safety. Only a quarter of office-based physicians have gone digital, according to the most recent CDC data.