Aaron Berdofe, MHI – Health Informatics

If there were awards given out on the amount of delays and procrastination one has when finishing their final master’s project, I think I should get one.  I’m not saying I was the best at it, but at least put me in the top 5%.  Anyway, over the course of the past 9 months I gestated on the following question: Can a clinic’s previous quality rankings determine their future EHR adoption status?

The vast majority of research on EHRs leading up to today has been whether they improve or harm the quality of patient care after they get implemented.  It’s been almost as if everyone just assumed that adding a computer into the situation makes things better.  And not just one aspect of patient care; all of them.  The US Government has even been operating under that very assumption by pumping billions of dollars into the industry through the HITECH Act.

And if that doesn’t work, just put the computer next to him and hope for the best.

However, a few voices have reached out over the years and quietly asked, what if it’s the other way around?  What if quality comes before the technology? Perhaps getting better tools is just something people with more advanced skills do.  After all, those of us who have acquired some sort of wearable health monitoring device (Fuelband, UP, Heart Rate Monitors, etc.) tend to be more healthy than the general population…but we were already healthier to begin with.  Being geeky is just a habit for some of us.

To answer my question, I pulled some historical quality rankings for Minnesota clinics from 2010 (because that was the only quality data available) and utilized the responses from a survey put together by the folks at the Minnesota Department of Health that has tracked EHR adoption progress in the state for the past 2 years.

It turns out that there is a pretty significant relationship between a clinic’s historical quality scores and their future EHR adoption level.  Now, this is respective to the small sample I was able to obtain in the state of Minnesota (a leader in healthcare quality and technology adoption), but if you look at the Meaningful Use dollars being given out, they indicate a very similar pattern across the nation. I’d also place my bets that if my research was repeated in various states, you’d see the same thing again and again.

Could an EHR be used to improve quality?  Yes, I think it can assist in the matter, but it’s most likely won’t be the cause.  I’ve long been a critique of EHR vendors because I don’t feel they truly have an idea of what problem their software is trying to solve in a clinical setting.  This project provides more evidence in my mind that I’m probably right.  We can use EHRs to help us measure quality indicators, but they should not be used as harbingers of positive (or negative) change.

Contact me if you’d like to see the full paper, otherwise I’m debating on attempting to get it published.