Electronic health records improve the quality of care in underserved populations: A literature review
This is a review of the article by Weinfeld et al., Electronic health records improve the quality of care in underserved populations: A literature review.
“Organizations in underserved settings are implementing or upgrading electronic health records EHRs in hopes of improving quality and meeting Federal goals for meaningful use of EHRs. However, much of the research that has been conducted on health information technology does not study use in underserved settings, or does not include EHRs. We conducted a structured literature search of MEDLINE to find articles supporting the contention that EHRs improve quality in underserved settings. We found 17 articles published between 2003 and 2011. These articles were mostly in urban settings, and most study types were descriptive in nature. The articles provide evidence that EHRs can improve documentation, process measures, guideline-adherence, and (to a lesser extent) outcome measures. Providers and managers believed that EHRs would improve the quality and efficiency of care. The limited quantity and quality of evidence point to a need for ongoing research in this area"(p. 136,).
Background and Purpose
The push for widespread adoption of EHR technology in the United States includes public health safety-net settings such as community health clinics and local public health departments. In addition to the often cited rationale for EHR implementation (improved safety and quality of care delivery) reduction in disparities of care are among the goals of health information technology (HIT) in the public health arena. The authors’ intention is to inform and enhance current and future efforts at EHR adoption in low resource settings that serve vulnerable populations.
There is a lack of research that investigates how HIT impacts care in community ambulatory settings that target underserved populations. This is needed because it is not known if these technologies translate or have similar impacts on quality of care in these settings. Consider the clinical guidelines and reminders that are part of EHR clinical decision support. These may not be effective in low-resource settings such as a community clinic if that clinic does not have the resources to provide the intervention the EHR recommends.
17 articles were reviewed. Quality improvement gains were realized through the use of various EHR features: templates, documentation, problem lists, and reminders. The general perception of clinical users was that quality of care was improved in underserved settings by the adoption of EHR technology. Several of the studies found substantial improvements in care outcome measures for safety-net practices using an EHR compared to those using paper methods. These improvements held for both Medicare patients and uninsured patients. Another article found large increases in the number of preventive procedures (diabetic foot exams, lipid level tests, HgA1c tests) performed after EHR implementation compared to baseline measures before implementation. Completeness of documentation was improved with the availability of an EHR as compared with paper systems. In one study, increased documentation of asthma severity and tracking of ED visits and hospitalizations drastically improved the use of asthma medications in urban children at a health center which added decision support to an existing EHR. Other articles provided evidence that clinical decision support also served to reduce the number of medications prescribed per patient and improve referral processes.
Despite the findings that show the usefulness of EHR technology in underserved settings, the quality of the evidence is weak and needs further study. Stakeholders involved in EHR implementation projects for underserved populations should focus on monitoring of cost, productivity and quality outcome measures to ensure benefits realization.
This article provides support for those involved in seeking funding and approval for EHR adoption for use in settings that serve patients who face barriers to healthcare access. Given the high cost and extensive resources required to implement EHR technology, it is challenging is to convince leadership that such HIT will have the same impact on quality of care delivery in these settings as is seen in private ambulatory settings.
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- Weinfeld, J. M., Davidson, L. W., & Mohan, V. (2012). Electronic health records improve the quality of care in underserved populations: A literature review. Journal of Health Care for the Poor and Underserved, 23(3), 136-153. doi:10.1353/hpu.2012.0134. http://muse.jhu.edu/login?auth=0&type=summary&url=/journals/journal_of_health_care_for_the_poor_and_underserved/v023/23.3A.weinfeld.html