Wednesday, March 18, 2009

The latest on EMRs and outcomes

A survey of Texas hospitals reported in the Archives of Internal Medicine concluded:

Hospitals with automated notes and records, order entry, and clinical decision support had fewer complications, lower mortality rates, and lower costs.

There’s no proof of cause and effect here although the results were adjusted for other variables. The raw data are not nearly as optimistic as the conclusion suggests. Clinical outcomes were mixed although there did seem to be fairly consistent cost saving.

The accompanying editorial was circumspect and made the point that since there will never be prospective randomized trials (too cumbersome and costly, and by the time they could be organized, given the current push for EMR adoption there would not be adequate comparison groups) we have to make the best of available lower level evidence. That evidence will need to be better than what’s offered here. Before and after implementation studies may be the most telling.

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