EHRs provide potential solutions for trimming unnecessary health care

As the healthcare system of nation sustains to grapple with the issues of overuse and low-value care that gives little or no benefit to sufferers, electronic health record (EHR) systems can offer potential solutions for trimming unnecessary health care. It can also serve as strong technology platforms for data collection and intervention to deal overutilization.

So elaborates David Bates, MD, chief of the Division of General Internal Medicine and Primary Care at Boston’s Brigham and Women’s Hospital and co-author of a new viewpoint article in the Journal of the American Medical Association. Electronic health record (EHR) systems can offer potential solutions for trimming unnecessary health care.

In the article, “We concentrate on the issue of overuse and what can be done about it,” claims Bates. “One of the greatest changes in healthcare in recent years is that we are now using electronic health records (EHRs), which could actually be very helpful in reducing the overuse problem.”

Bates and his co-authors assert that EHRs have inherent advantages in combating the overuse of diagnostic processes, like the ordering of unnecessary tests by clinicians. They see the EHR as “an ideal medium” to give that kind of critical clinical decision support.

Although, the authors of the opinion piece also point out the limitations of EHRs the way that they are presently configured.

“There is lots of overuse, and EHRs do not necessarily do all they can to help reduce the frequency,” Bates adds. “The decision support in several of them is not as good as it should be. EHRs should routinely recognize things that are redundant, and they should assist people recognize things that are unnecessary. But most of the EHRs that are in broad use today aren’t doing that routinely.”

Bates and his co-authors give 3 current examples of U.S. healthcare organizations with mature EHRs:

• One agency has incorporated 100 of the American Board of Internal Medicine’s “Choosing Wisely” recommendations into their EHR to develop automated alerts that provide physicians with evidence and alternative options.


• Another agency aggregates data to compare physician orders against each another.


• The third integrated delivery system mines patient records to give physicians with best practices prior to a visit.

“We do not have robust evidence about which of the 3 works best,” Bates appreciates. “All three would be reasonable approaches to take—probably what we require at the end of the day is some amalgam of the three.”

At the similar time, he notes that EHRs “should be used to straightly influence physician behavior at the point of care, and that is what organization A is doing” by giving an alert in real time to physicians with patients who fit a Choosing Wisely scenario.

Nevertheless, Bates gives that organization B is “looking more at variation and that is also a very strong approach for finding situations in which there is overuse.”

Finally, he summarizes that all healthcare agencies will need to customize their respective EHR systems to establish tailored solutions and trimming unnecessary health care that best fit their requirements.