Health Information Technology: Shall We Wait for the Evidence?

A preventable medical error caused my grandmother's death. Her physician's office was a sea of paper, without automated workflow tools, decision support, or electronic documentation. Would electronic health records (EHRs) and e-prescribing have warned her physician that high-dose nonsteroidal anti-inflammatory drugs might induce a gastrointestinal bleeding episode in an octogenarian receiving prednisone? Very likely. Do we have proof from randomized clinical trials done in rural clinician offices? We do not.

In this issue, Chaudhry and colleagues (1) note that 25% of the health information technology (HIT) efficacy literature is from 4 institutions, each of which has developed its own EHR system. These 4 sites have convincingly documented the positive effects of HIT on quality, efficiency, and costs. It has 1) increased delivery of care in adherence with guidelines and protocols, 2) enhanced capacity to perform surveillance and monitoring for disease conditions, 3) reduced rates of medication errors, 4) decreased utilization of care, and 5) had mixed effects on physicians' time utilization. In view of the limited evidence, Chaudhry and colleagues conclude that many stakeholders who are seeking to make information technology investments will struggle to replicate the experience of these 4 sites in typical health care facilities using commercial software packages.

I accept the authors' conclusion that we have incomplete evidence of the effect of many forms of clinical automation in many settings. However, …