EHRs Can Reduce Overuse, Low-Value Care

According to a recent viewpoint in JAMA, electronic health record (EHRs) systems can help to reduce medical overuse and decrease the prevalence of low-value care by allowing for better data collection and direct intervention.

“EHRs represent a key opportunity to begin to address overuse and the high costs of care and to realize benefit from one of the country’s major health care investments,” David W Bates, MD, division of general internal medicine and primary care within the department of medicine at Brigham and Women's Hospital, and colleagues at RAND Health wrote. “Even though the EHR platform has many limitations for data collection, its advantages are clear.”

According to the commentary, EHRs allow for real-time clinical decision support with feedback over time. The authors suggest that the ability to allow tailored solutions to each patient and their needs, make EHRs a unique area of focus for targeting reductions in overuse. 

Despite a universal acknowledgement of overuse and its adverse effects on cost, health performance measures have primarily focused on what physicians should do for patients, and not what they should not do, according to the authors. Currently, financial incentives have been geared towards underuse, and current estimates of overuse are imprecise—researchers are worried about inconsistencies in definitions, datasets, and denominators.

The authors proposed 3 scenarios in which EHRs could help to curb overuse. These include incorporating 100 of the American Board of Internal Medicine’s “Choosing Wisely” recommendations into their EHR to create automated alerts, aggregating data to compare physician orders against each another, and integrating delivery systems that mine patient records to provide physicians with best practices prior to a visit.

Dr Bates and colleague contend that “the EHR represents an ideal medium to provide clinical decision support in a real-time setting.”

The authors concluded that EHRs can be employed to reduce overuse, but currently popular EHR systems that are in use do not have the capabilities to help physicians identify areas where medical services are redundant.

“The EHR has the potential to be a powerful vehicle for measurement and intervention around low-value care,” Dr Bates and colleagues wrote. “While innovative organizations have adopted several EHR-based approaches to reduce low-value care, the best choices remain to be determined, and combinations may work best; choices may depend on institutional and clinician characteristics.”

—Julie Gould (Mazurkiewicz)

Reference:

Rumball-Smith J, Shekelle PG, Bates DW. Using the Electronic Health Record to Understand and Minimize Overuse [published online January 17, 2017]. JAMA. 2016(317):3.