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Doctors' Use of EHRs Linked to Variability in Records' Application

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Physicians develop their own patterns of using electronic health records (EHR) — digital systems for patients' medical histories — resulting in tremendous variability in the records' use at the provider level. Understanding the dynamics between physicians and the health information technology sheds light on which aspects of the records work well and which aspects need to be improved in order to standardize healthcare delivery.

A research team, led by Dr. Jessica Ancker, collaborated with The Institute for Family Health, a network of 18 New York City health centers, to analyze EHR data from 112 doctors between 2010 and 2013. Their study, published in the Journal of the American Medical Informatics Association, analyzed 430,803 encounters of EHR use across 99,649 patients. The results revealed how physicians use EHR features differently, such as how often they respond to alerts from the system, or how frequently they update a patient's problem list, the inventory of a patient's most significant medical conditions.

"The variability really reinforces that the EHR is not a black box where you plug in this software and it's going to change everything for the better. The patients and the doctors and the software are all interacting in a pretty complex and nuanced way," said Dr. Ancker, an assistant professor of healthcare policy and research at Weill Cornell.

Analyzing this complex interaction reveals how EHRs can be improved to optimally serve physicians and patients. For example, there seems to be widespread acceptance at the institute of the cancer-screening alerts incorporated within its EHR system. However, too many system alerts decrease physicians' response rates to them — a finding that Dr. Ancker quips is akin to ignoring your mother the more she nags you. Eliminating burdensome elements of EHRs and honing in on their most valuable features can help doctors to be increasingly effective and efficient with their patients, she says.

The study follows a related publication of Dr. Ancker's in the Journal of General Internal Medicine, which found that use of personal health records (PHR) — the slice of EHRs that patients have access to — increased from 11 percent to 17 percent over just one year, from 2012 to 2013. Similarly to EHRs, increasing PHR use stands to move healthcare forward as well.

"The hope is that PHR breaks down a little bit of the barrier between specialized medical knowledge and the patient. The patient should be able to learn more about their health and very actively take control of their health," Dr. Ancker said.

"EHR and PHR both have the potential to improve the way we deliver healthcare in this country, giving higher quality care and getting patients more engaged in their own healthcare, leading to downstream healthier people."

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