Lack of association between electronic health record systems and improvement in use of evidence-based heart failure therapies in outpatient cardiology practices

Abstract

Background: Electronic health record systems (EHR) are expected to facilitate higher quality patient care; however, studies evaluating EHR effectiveness in improving care have yielded mixed results.

Hypothesis: Implementation of a performance improvement system in outpatient practices with EHR may better demonstrate the value of EHR in improving quality.

Methods: The Registry to Improve the Use of Evidence-Based Heart Failure Therapies in the Outpatient Setting (IMPROVE HF) prospectively evaluated the effectiveness of a performance improvement initiative on use of evidence-based therapies for patients with heart failure (HF) or prior MI and LVSD. This study assessed improvement in the use of 7 quality measures from baseline to 24 months.

Results: Complete data were available for 155 of 167 (92.8%) practices; 78 (50.3%) used EHR always, 15 (9.7%) switched to EHR, and 61 (39.4%) used paper always. EHR-always practices had significantly improved adherence to 5 measures at 24 months, and EHR-switched or paper-always practices had improved adherence to 6 measures. With a single exception, there were no significant differences in the magnitude of improvements in use of guideline-recommended care among the 3 practice types. Performance on individual quality measures was also similar at 24 months.

Conclusions: Implementation of the performance improvement intervention enhanced use of guideline-recommended HF therapies among outpatient cardiology practices. However, practices using or converting to EHR did not achieve greater improvements in quality of HF care than practices using paper systems. These findings raise doubts about whether implementation of EHR nationally will translate into better outpatient quality of care.

Figure 1

Rates of adherence to 7 quality measures at baseline and 24 months for (A) electronic health record systems (EHR)‐always, (B) EHR‐switched, and (C) paper‐always practices. All patients eligible for an individual quality measure at baseline or at 24 months were included. Abbreviations: ACEI/ARB, angiotensin‐converting enzyme inhibitor/ angiotensin receptor blocker; CRT, cardiac resynchronization therapy; EHR, electronic health record; HF, heart failure; ICD, implantable cardioverter‐defibrillator.