Electronic Health Record Use and the Quality of Ambulatory Care in the United States
Abstract
BACKGROUND: Electronic health records (EHRs) have been proposed as a sustainable solution for improving the quality of medical care. We assessed the association between EHR use, as implemented, and the quality of ambulatory care in a nationally representative survey. METHODS: We performed a retrospective, cross-sectional analysis of visits in the 2003 and 2004 National Ambulatory Medical Care Survey. We examined EHR use throughout the United States and the association of EHR use with 17 ambulatory quality indicators. Performance on quality indicators was defined as the percentage of applicable visits in which patients received recommended care. RESULTS: Electronic health records were used in 18% (95% confidence interval [CI], 15%-22%) of the estimated 1.8 billion ambulatory visits (95% CI, 1.7-2.0 billion) in the United States in 2003 and 2004. For 14 of the 17 quality indicators, there was no significant difference in performance between visits with vs without EHR use. Categories of these indicators included medical management of common diseases, recommended antibiotic prescribing, preventive counseling, screening tests, and avoiding potentially inappropriate medication prescribing in elderly patients. For 2 quality indicators, visits to medical practices using EHRs had significantly better performance: avoiding benzodiazepine use for patients with depression (91% vs 84%; P = .01) and avoiding routine urinalysis during general medical examinations (94% vs 91%; P = .003). For 1 quality indicator, visits to practices using EHRs had significantly worse quality: statin prescribing to patients with hypercholesterolemia (33% vs 47%; P = .01). CONCLUSION: As implemented, EHRs were not associated with better quality ambulatory care.
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Simply having an electronic health record appears to have little impact on quality by itself.
“Simply having an electronic health record appears to have little impact on quality by itself.3 4”
From Overrides of medication-related clinical decision support alerts in outpatients (2014) · cites this paper as [3]
Most available studies were conducted by EHR developers and examined only a few error types related to order entry (CPOE).
“The few available studies have largely been conducted by the developers of the EHRs and have focused on the effect of order entry (CPOE) systems on a limited number of error types.[17][18][19][20]”
From EHR Safety: The Way Forward to Safe and Effective Systems (2008) · cites this paper as [20]
The first two widely cited CPOE studies did not demonstrate improvements in patient outcomes.
“Although the first two studies have been widely cited as showing CPOE benefits, neither showed improvements in patient outcomes.20 -22”
From EHR Safety: The Way Forward to Safe and Effective Systems (2008) · cites this paper as [20]
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- Authors
- Linder, J. A., Ma, J., Bates, D. W., Middleton, B., & Stafford, R. S.
- Affiliations
- Brigham and Women's Hospital (US)
- Venue
- Archives of Internal Medicine
- Publisher
- American Medical Association (AMA)
- Published
- 2007-07-09
- Volume
- 167
- Issue
- 13
- Pages
- 1400
- ISSN
- 0003-9926 (ISSN-L)
- OpenAlex
- W2160379455
- Cited by
- 438
- References
- 24
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 3 · 2023: 2 · 2022: 12 · 2021: 5 · 2020: 7 · 2019: 20 · 2018: 20 · 2017: 14 · 2016: 31 · 2015: 27 · 2014: 34 · 2013: 40 · 2012: 42
- FWCI
- 96.63
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Archives of Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Agency for Healthcare Research and Quality (R01 HS11313, K08HS014563)
- Topics
- Health Sciences › Health Professions › Health Information Management › Electronic Health Records Systems
- Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
- Health Sciences › Health Professions › Health Information Management › Medical Coding and Health Information
- Keywords
- electronic health records, ambulatory care quality, quality indicators, EHR adoption, antibiotic prescribing, benzodiazepine prescribing, statin prescribing, hypercholesterolemia, urine analysis, preventive counseling, National Ambulatory Medical Care Survey
- MeSH terms
- Adolescent, Adult, Ambulatory Care, Cross-Sectional Studies, Female, Health Surveys, Humans, Male, Middle Aged, Quality of Health Care, Retrospective Studies, United States, Medical Records Systems, Computerized, Smoking Cessation
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