HIMSS' survey of EHR value seems a bit misleading

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I've lamented before about the sometimes self serving, misleading or simply unhelpful studies that have been propagated about electronic health records.

But these beauties keep on appearing. The latest one is from the Healthcare Information and Management Systems Society (HIMSS), which released a survey this week about how EHRs are proving their worth. Most--88 percent--of the health information management respondents identified at least one positive outcome of EHRs; 83 percent said that the EHR provided increased efficiencies in clinical staff quality performance and 52 percent reported increased clinical staff productivity. More than four-fifths (81 percent) reported a positive impact on savings. 

The accompanying announcement notes that the survey shows the "progress that healthcare industry has made" in reaping value from their EHR investments and that health IT is "creating a positive shift within healthcare organizations" that's "deriving quality care and improved outcomes."  

OK. But the spin on the numbers is misleading. We almost learn more from what HIMSS doesn't say.

For one, HIMSS surveyed only executives from hospitals that were using the most advanced EHRs. Why then were only 88 percent of respondents identifying at least one positive outcome of EHRs? Why were only half of them were enjoying increased clinical staff productivity? And considering the cost to implement advanced EHR systems--including installation, training and maintenance--why weren't more of them seeing multiple positives?

And that positive impact of savings? The most savings were in coding accuracy, accounts receivable and transcription costs. So why isn't that number higher? Don't all EHRs help in those areas? 

Then look at patient engagement. Sixty-nine percent of respondents implemented a formal patient engagement strategy; 61 percent reported use of a patient portal and 50 percent were distributing education material to patients. But since these are requirements of the Meaningful Use program, and these are hospitals with advanced systems, again, shouldn't more of them be in compliance with Meaningful Use?

My favorite part is about clinician satisfaction. HIMSS reports that 44 percent of respondents said that the nurses in their organization were satisfied and 29 percent of the doctors were satisfied. Why are these numbers so low in organizations that have fully embraced the technology? And why doesn't the survey say "only?" Are 44 percent and 29 percent supposed to be good numbers?

Additionally, why are the clinicians so unhappy? Were the EHRs thrust on them without clinician input? Are they difficult to use? Do the information management respondents even really know what the clinicians think of the EHRs? Did they ask them?

In other words, shouldn't these healthcare organizations be seeing more value? What's gone wrong?

I'm also concerned that HIMSS only surveyed executives at facilities with advanced systems. Is it even worse with providers using more basic health IT? Are there disparities in EHR use that should be addressed?

And how much can we really rely on a survey of only 52 people?

I'm not trying to target HIMSS; I don't want to dismiss a study that may have merit in it. But so far I don't see a benefit to this survey. In a time when the industry is at a real crossroads--the Meaningful Use program, outcomes based payments, interoperability--it needs more useful information and a straightforward portrayal of it. - Marla (@MarlaHirsch and @FierceHealthIT)

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