Secondary Logo

Institutional members access full text with Ovid®

Share this article on:

Relationship Between Use of Electronic Health Record Features and Health Care Quality: Results of a Statewide Survey

Poon, Eric G. MD, MPH*†; Wright, Adam PhD*†‡; Simon, Steven R. MD, MPH†§; Jenter, Chelsea A. MPH*; Kaushal, Rainu MD, MPH; Volk, Lynn A. MHS; Cleary, Paul D. PhD; Singer, Janice A. MPH**; Tumolo, Alexis Z. BS*; Bates, David W. MD, MSc*†‡

doi: 10.1097/MLR.0b013e3181c16203
Original Article

Background: Electronic health records (EHRs) are widely viewed as useful tools for supporting the provision of high quality healthcare. However, evidence regarding their effectiveness for this purpose is mixed, and existing studies have generally considered EHR usage a binary factor and have not considered the availability and use of specific EHR features.

Objective: To assess the relationship between the use of an EHR and the use of specific EHR features with quality of care.

Research Design: A statewide mail survey of physicians in Massachusetts conducted in 2005. The results of the survey were linked with Healthcare Effectiveness Data and Information Set (HEDIS) quality measures, and generalized linear regression models were estimated to examine the associations between the use of EHRs and specific EHR features with quality measures, adjusting for physician practice characteristics.

Subjects: A stratified random sample of 1884 licensed physicians in Massachusetts, 1345 of whom responded. Of these, 507 had HEDIS measures available and were included in the analysis (measures are only available for primary care providers).

Measure: Performance on HEDIS quality measures.

Results: The survey had a response rate of 71%. There was no statistically significant association between use of an EHR as a binary factor and performance on any of the HEDIS measure groups. However, there were statistically significant associations between the use of many, but not all, specific EHR features and HEDIS measure group scores. The associations were strongest for the problem list, visit note and radiology test result EHR features and for quality measures relating to women's health, colon cancer screening, and cancer prevention. For example, users of problem list functionality performed better on women's health, depression, colon cancer screening, and cancer prevention measures, with problem list users outperforming nonusers by 3.3% to 9.6% points on HEDIS measure group scores (all significant at the P < 0.05 level). However, these associations were not universal.

Conclusions: Consistent with past studies, there was no significant relationship between use of EHR as a binary factor and performance on quality measures. However, availability and use of specific EHR features by primary care physicians was associated with higher performance on certain quality measures. These results suggest that, to maximize health care quality, developers, implementers and certifiers of EHRs should focus on increasing the adoption of robust EHR systems and increasing the use of specific features rather than simply aiming to deploy an EHR regardless of functionality.


From the *Division of General Medicine, Brigham and Women's Hospital, Boston, MA; †Department of Medicine, Harvard Medical School, Boston, MA; ‡Partners HealthCare, Boston, MA; §Harvard Pilgrim Health Care, Boston, MA; ¶Division of Quality and Medical Informatics, Weill Cornell Medical College, New York, NY; ∥Yale University School of Public Health, Yale School of Medicine, New Haven, CT; and **Massachusetts Health Quality Partners, Watertown, MA.

Drs. Poon and Wright contributed equally to this paper.

Supported by an R01 Grant from the Agency for Healthcare Research and Quality as well as funds from the Massachusetts eHealth Collaborative.

Presented as a poster at the 2007 annual meeting of the Society of General Internal Medicine.

E.G.P. and A.W. had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

The funding agencies had no role in the design of the study, analysis of the data, interpretation of the results, or the decision to publish.

Reprints: Adam Wright, PhD, Division of General Medicine and Primary Care, Brigham and Women's Hospital, 1620 Tremont St., Boston, MA 02120. E-mail:

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

© 2010 Lippincott Williams & Wilkins, Inc.