EHR;this study
Manual reviews of both paper and electronic records were used to
compare performance on clinical quality measures before and after EHR adoption.
Performance did not change significantly before EHR adoption, while performance
patterns after EHR adoption varied by measure. All of the selected measures
were commonly
well-known and validated care recommendations monitored by payers
and purchasers of health care, and for which small improvements have been
observed both in national trends25 and locally in New York City.Much of the recent literature has highlighted the overwhelmingly
positive improvement of primary and secondary preventive services after the
adoption of EHR;this study highlights the specific changes observed after
the target team member login conversion to EHR and the time it may take for those changes to occur.
The level of complexity of the new workflows needed to document
preventive services after EHR implementation may offer insight into the
patterns of quality measure performance we observed. Diversity in practice
workflow styles and preferences may also explain the lack of consensus
regarding how long to wait after EHR implementation to examine its effect. The three trends observed—improvement, decline followed by
rebound, and no change—offer examples of potential impact on practice workflow.
Measures in which performance increases were observed soon after
EHR adoption were associated with medical record elements that could all be
documented within the context of a single office visit. For example, a provider
can record a patient’s smoking status and vitals and can prescribe or continue
a medication during a brief patient visit. Data capture of these elements does
not require any further coordination or outside resources.
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