The Role of Electronic Medical Records in Reducing Unwarranted Clinical Variation in Acute Health Care: Systematic Review.

Tobias Hodgson,Andrew Burton-Jones,Clair Sullivan,Raelene Donovan

doi:10.2196/30432

Abstract

BackgroundThe use of electronic medical records (EMRs)/electronic health records (EHRs) provides potential to reduce unwarranted clinical variation and thereby improve patient health care outcomes. Minimization of unwarranted clinical variation may raise and refine the standard of patient care provided and satisfy the quadruple aim of health care.ObjectiveA systematic review of the impact of EMRs and specific subcomponents (PowerPlans/SmartSets) on variation in clinical care processes in hospital settings was undertaken to summarize the existing literature on the effects of EMRs on clinical variation and patient outcomes.MethodsArticles from January 2000 to November 2020 were identified through a comprehensive search that examined EMRs/EHRs and clinical variation or PowerPlans/SmartSets. Thirty-six articles met the inclusion criteria. Articles were examined for evidence for EMR-induced changes in variation and effects on health care outcomes and mapped to the quadruple aim of health care.ResultsMost of the studies reported positive effects of EMR-related interventions (30/36, 83%). All of the 36 included studies discussed clinical variation, but only half measured it (18/36, 50%). Those studies that measured variation generally examined how changes to variation affected individual patient care (11/36, 31%) or costs (9/36, 25%), while other outcomes (population health and clinician experience) were seldom studied. High-quality study designs were rare.ConclusionsThe literature provides some evidence that EMRs can help reduce unwarranted clinical variation and thereby improve health care outcomes. However, the evidence is surprisingly thin because of insufficient attention to the measurement of clinical variation, and to the chain of evidence from EMRs to variation in clinical practices to health care outcomes.

Highlights

Variation in Health CareAny health care service seeks to raise and refine the standard of care it provides to patients and to satisfy the quadruple aim of health care, that is, to improve patient care, population health, cost of care, and clinician experience [1,2]
This review focuses on 2 clinical decision support (CDS) components from the 2 most prevalent electronic medical record (EMR) vendors globally (>50% of acute care market), with products that have similar aims to help reduce unwarranted clinical variation: PowerPlan (Cerner Corporation) and SmartSet (Epic Systems Corporation) [27,28,29]:
This review finds some evidence to justify that EMRs can help reduce unwanted clinical variation and thereby improve health care outcomes

Summary

Introduction

Variation in Health CareAny health care service seeks to raise and refine the standard of care it provides to patients and to satisfy the quadruple aim of health care, that is, to improve patient care, population health, cost of care, and clinician experience [1,2]. The use of electronic medical records (EMRs)/electronic health records (EHRs) provides potential to reduce unwarranted clinical variation and thereby improve patient health care outcomes. Minimization of unwarranted clinical variation may raise and refine the standard of patient care provided and satisfy the quadruple aim of health care. Articles were examined for evidence for EMR-induced changes in variation and effects on health care outcomes and mapped to the quadruple aim of health care. All of the 36 included studies discussed clinical variation, but only half measured it (18/36, 50%) Those studies that measured variation generally examined how changes to variation affected individual patient care (11/36, 31%) or costs (9/36, 25%), while other outcomes (population health and clinician experience) were seldom studied. Conclusions: The literature provides some evidence that EMRs can help reduce unwarranted clinical variation and thereby improve health care outcomes. The evidence is surprisingly thin because of insufficient attention to the measurement of clinical variation, and to the chain of evidence from EMRs to variation in clinical practices to health care outcomes

Methods

Results

Discussion

Conclusion