EHRs Not Sufficient to Improve the Quality of Stroke Care

EHRsElectronic health records (EHRs) are supposed to enhance the clinical outcomes with faster data input, exchange and retrieval. EHR is regarded as an effective clinical documentation tool to improve the quality of care for conditions for which guidelines are quickly evolving and timely care is crucial. However, this system doesn’t seem to be an outstanding solution to provide quality care for stroke patients, a study confirms. The study says EHRs may be necessary for a high-tech, transparent healthcare system, but do not appear to be sufficient to improve the clinical outcomes for stroke, as currently implemented.

The purpose of this study published in the Journal of the American College of Cardiology was to find out whether hospitals with EHRs differed in quality or outcome measures for ischemic stroke from those without EHRs. The researchers studied 626,473 patients from 1,236 U.S. hospitals in Get with the Guidelines-Stroke (GWTG-Stroke) from 2007 through 2010, associated with the American Hospital Association annual survey as a part of the study for understanding the presence of EHRs. At the end of the study period, a total of 511 hospitals were found to have EHRs. Those hospitals were larger and were more often teaching hospitals and stroke centers.

After controlling for patient and hospital characteristics, the overall study of hospitals with and without EHRs revealed that patients who were admitted to hospitals with EHRs had similar odds of receiving ‘all-or-none’ care, of discharge home and of in-hospital mortality compared to hospitals without EHRs. Moreover, the odds of having a length of stay more than four days were slightly lower at hospitals with EHRs than in hospitals without EHRs. This proved that the electronic record system was not associated with either higher-quality care or better outcomes for stroke care.

Though the electronic health record system is effective and has been heavily subsidized under the American Recovery and Reinvestment Act, its capability in handling complex cases like stroke is in doubt, with these study findings. The lead author of this study, Dr. Karen Joynt says EHR interfaces are not capable to link people together to care for complex patients. Patients require rehabilitation care, potentially occupational therapy, speech therapy, physical therapy and get their medications correct to survive the stroke. EHR doesn’t take care of all that.

As per John R. Windle, who wrote a corresponding editorial comment to this study, the first priority of EHRs must be giving support to clinical care, not documentation for billing and reimbursement that adds burden and results in neither value, nor patient health or safety. A new policy statement from the American College of Physicians also suggests the need to focus less on lists of check boxes and reimbursement while paying more attention to narrative entries and the designs that enhance patient care. According to this statement, documenting clinical information with drop-down lists, check boxes, macros, and templates can be distracting and disruptive to vital clinical thinking as well as storytelling. This will lead to over-structuring the clinical record and overloading it with irrelevant data.

Overall, a more comprehensive approach for clinical documentation is necessary to ensure patient safety. Here comes the significance of a hybrid approach involving EHR and medical transcription. In this approach, the dictations are transcribed with the help of experienced transcriptionists and the transcribed data is entered into the corresponding EHR fields. This supports narrative description as well as improves the accuracy of clinical data.