Health Information System, Research Paper Example

Introduction

There have been recent advances in technology that promote the use of electronic health records (EHR) to help facilitate the overall quality and experience the patient experiences while receiving health care services.  The push to adopt the use of EHRs has been on the federal government’s agenda since 2004 (Crosson, Ohman-Strickland, Cohen, Clark and Crabtree 2012).  The study focuses specifically on the use of EHRs for ambulatory services and community based primary care and the relationship EHRs have on the quality of the care provided.  The purpose of the study was to determine if there was a correlation between the use of EHRs, the quality of the care experienced by the client and the overall rates for improvement regarding the patient’s health concern.  The importance of this study is derived from the outcome of the particular correlation between the EHR, overall care of the patient and the outcome of the treatment.  While the treatments trend in the same direction with or without EHR the real results stem from the improvement in the quality of treatment which impacts the patient directly.  The content of the piece was well put together and contained multiple reputable and verifiable sources that provided a sense of authority and expertise in the field in which the study was conducted.

Review/Framework

The literature review was short, concise and pointed to the fact that prior studies lacked the necessary observational time-frames and did not include a broad enough target to fully understand the impact of EHRs to make a conclusive analysis on the impact to outcome of the treatment.  The study conducted in this project is addressing some of the gaps the other studies did not address.  In order to eliminate the gap in the long-term study, the researchers pulled together data for approximately three years from practices that implemented EHR.  The literature does not allude to how a specific cross-functional study would be conducted or how it would be handled in this analysis. The link between the previous research and the research being conducted for this project is apparent and the researchers are building on the foundation that was built by prior research projects.

The theoretical framework presented in this study is that there is a potential correlation between the use of EHRs and the outcome of the treatment.  The basis of the framework is trying to tie two variables to the end result.  The two variables are the implementation of the EHR system in the practice and the complete inverse which the practice continues to handle all of their work through manual paper copies of the health records.  While the hypothesis was not directly stated the intent of the study was to provide clarity regarding the relationship between the manual or automated inputs of the process and the end result. Since the hypothesis was not clearly stated the study presented itself as a way to gain an overall understanding on the entire situation.  This type of study seemed more exploratory in nature than a study testing a specific theory.  The key point for an exploratory study would be for the people conducting the study to remain unbiased.  This seemed to be slightly difficult from the beginning considering the team critiqued a group of prior studies and looked to fill the gaps specifically of those that came before them.

Methodology

The variables in this study include but are not limited to the fact that certain practices use EHR systems and others do not.  The study pulled in sixteen EHR-using practices and 26 non-EHR-using practices.  The group of patients was limited to those treating diabetes and the measurements were based on the relationship between EHR use, use of evidence based care guidelines and the rates of improvement.  The data was generated for a three year time period in order to provide a depth of treatment history and potentially eliminate the impact of outlier data points that may skew a smaller data set.  The methods were appropriately modified for the intent of the study.  The study wanted to incorporate data that would address the deficiency of the short term studies and by including the three year of data into the analysis the study’s underlying purpose was fulfilled.  As the description of the methodology progressed, the study addressed the data collection methods and how the variables and concepts were defined.  The data collection came from multiple teams that specific teams that were charged with gathering and reporting the information collected based on the guidance provided by their project’s charter.  The potential threats to the validity of the study include not fully understanding what “quality” entails and understanding the severity of the ailments that were being treated at each practice.  If the diabetic conditions of all the patients were, in essence, similar in severity and treatability the overall outcome could be directed to the variable of the EHR system or traditional paper system.  The extraneous variables that influence the outcomes were not mentioned, documented or controlled.

The sample size was initially larger than the reported forty two practices (16 EHR and 26 non-EHR).  Due to some of the practices leaving the study or transition from non-EHR to EHR systems, the sample size was reduced significantly.  This did not impact the overall sufficiency of the sample size as there were still enough of both groups to conduct a thorough study.  The variables were not fully identified outside of the two main variables of EHR or non-EHR.  This lead to more questions than answers as the review of the article continued.

Results/Conclusion

The results of the study were somewhat ambiguous in relationship to the purpose of the study.  The results showed that there should be much more work conducted by the practices to fully implement their EHR systems and improve their in-house processes to fully utilize the functionality of the EHR system.  This includes modifying business processes and internal practices to facilitate the use of the system.  The findings did not conclude that either practice inherently improves the treatment results of the patients.  The study did allude to the fact that overall both groups were receiving better health care treatment but still fell below a consistent standard.  Both groups fell below the recommended outcome target with less than 1 in 5 patients meeting the target.  The study did shed light on the fact that if EHR is seen as a tool to facilitate change and progress, the tool is useless unless implemented with the proper support, training and business process changes.

The study has great relevance to the practice because it sheds light on the areas that are manageable by each practice so that each could provide better care to their patients.  The overall study determined that the implementation itself was not an answer for improved patient results.  It did present the weaknesses and the potential negated proposed benefits of EHR if not implemented in full.

References

Crabtree BF, Nutting PA, Miller WL, Stange KC, Stewart EE, Jaen CR. (2010) Summary of the National Demonstration Project and recommendations for the patient-centered medical home. Ann Fam Med. 8(Suppl 1):S80-S90, S92.

Crosson, J., Ohman-Strickland, P., Cohen, D., Clark, E., and Crabtree B., (2011) Typical electronic health record use in primary care practices and the quality of diabetes care. Annals of Family Medicine. Retrieved from www.annfammed.org. 10(3).

Linder JA, Ma J, Bates DW, Middleton B, and Stafford RS.( 2007) Electronic health record use and the quality of ambulatory care in the United States. Arch Intern Med. 167(13):1400-1405