Cohen and Dorr find Electronic Health Records systems are not doing all they can

Deb Cohen, Ph.D.

Since 2008, adoption of office-based EHR systems has more than doubled

Federal value-based payment programs require providers to use clinical quality measures generated by their EHRs to conduct quality improvement activities.

Little has been known about how well EHRs meet these expectations. Deborah Cohen, Ph.D., David Dorr, M.D., M.S., coauthored findings of research conducted to assess the benefits of EHR use in quality improvement work. The paper, “Primary Care Practices’ Abilities and Challenges in Using Health Record Data for Quality Improvement,” was published in the April 2018 issue of Health Affairs.

David Dorr, M.D., M.S.
Co-author David Dorr, M.D., M.S.,  was recently named chief research information officer at OHSU.

EHRs not meeting goals to improve quality of care

The Agency for Healthcare Research and Quality, through the EvidenceNOW program, is focusing on providing primary care practices with practice supports and quality improvement strategies. Cohen and Dorr are collaborators in ESCALATES, the evaluation team studying which supports and strategies are most effective.

Cohen, professor in the Department of Family Medicine, and Dorr, professor of medical informatics and clinical epidemiology, both in the School of Medicine, found EHRs and the reports they produce do not necessarily support quality improvement initiatives. Instead, practices reported significant challenges in pulling adequate data and struggles with functionality. They found that most vendors were unwilling to improve the EHR configuration beyond meeting federal requirements.

Policy recommendations

The authors, which include Kyle Knierim, M.D., from the University of Colorado School of Medicine, and other collaborators from the ESCALATES evaluation team, concluded that policy makers should consider empowering the Centers for Medicare and Medicaid Services and the Office of the National Coordinator for Health IT to expand their standards and requirements for, and monitoring of, EHR vendors. With this extra effort, EHRs and the reporting functionality these systems could better meet data needs for quality improvement, and better align with federal quality payment programs.

This research was supported by the Agency for Healthcare Research and Quality (R01HS023940-01).