EHRs offer possible solution for trimming unnecessary healthcare

As the nation’s healthcare system continues to grapple with the problems of overuse and low-value care that provides little or no benefit to patients, electronic health record systems can serve as powerful technology platforms for data collection and intervention to address overutilization.

So argues David Bates, MD, chief of the Division of General Internal Medicine and Primary Care at Boston’s Brigham and Women’s Hospital and co-author of a new viewpoint article in the Journal of the American Medical Association.

In the article, “We focus on the problem of overuse and what can be done about it,” says Bates. “One of the biggest changes in healthcare in recent years is that we are now using electronic health records, which could really be very helpful in decreasing the overuse problem.”

Bates and his co-authors contend that EHRs have inherent advantages in combating the overuse of diagnostic procedures, such as the ordering of unnecessary tests by clinicians. They see the EHR as “an ideal medium” to provide that kind of critical clinical decision support.

However, the authors of the opinion piece also point out the limitations of EHRs the way that they are currently configured.

“There is lots of overuse, and EHRs don’t necessarily do all they can to help decrease the frequency,” Bates adds. “The decision support in many of them is not as good as it should be. EHRs should routinely identify things that are redundant, and they should help people identify things that are unnecessary. But most of the EHRs that are in broad use today are not doing that routinely.”

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Bates and his co-authors provide three current examples of U.S. healthcare organizations with mature EHRs:

• One organization has incorporated 100 of the American Board of Internal Medicine’s “Choosing Wisely” recommendations into their EHR to create automated alerts that provide physicians with evidence and alternative options.
  
• Another organization aggregates data to compare physician orders against each another.
  
• The third integrated delivery system mines patient records to provide physicians with best practices prior to a visit.
  

“We don’t have robust evidence about which of the three works best,” Bates acknowledges. “All three would be reasonable approaches to take—probably what we need at the end of the day is some amalgam of the three.”


At the same time, he notes that EHRs “should be used to directly influence physician behavior at the point of care, and that’s what organization A is doing” by providing an alert in real time to physicians with patients who fit a Choosing Wisely scenario.

Nonetheless, Bates offers that organization B is “looking more at variation, and that’s also a very powerful approach for finding situations in which there is overuse.”

Ultimately, he concludes that all healthcare organizations will want to customize their respective EHR systems to create tailored solutions that best fit their needs.

“The benefits are that you can really tune it and get more value from it,” Bates concludes. “The downside is the more you tune it, the more you lose when you upgrade, because typically changes that you put in go away when you upgrade, and you have to then redo them—which can be a lot of work.”