EHRs, I can has antidepressants?

The news has been making the rounds. Electronic health records don't aid patient care. Not all of the Presidential candidates are going to be happy to hear this.

But enough about the candidates. I was originally going to rant about the MSM and the paucity of information they always give out on important topics in science and medicine. Fortunately, before I could go too far off into the deep end, I thought to look for the press release. Silly me, I should have remembered that press releases are usually full of fluff. So, just this once, I'll give the corporate-owned media bobos a get-out-jail-free card.

Still, it would be nice if somebody who [1] understands this stuff, [2] has access to the literature, and [3] can write would report on it. I've found the abstract of the journal article, but if I paid $15 each time I wanted to read an article, I'd never be able to feed kittens. And look, down at the bottom of the press release, you see that this research was funded by the U.S. Agency for Healthcare Research and Quality. I'm thinking that .gov in the URL means that my tax dollars paid for this research. I don't think I should have to pay extra to read the results.

So, anyway, just looking at the abstract---

Results Electronic health records were used in 18% (95% confidence interval [CI], 15%-22%) of the estimated 1.8 billion ambulatory visits (95% CI, 1.7-2.0 billion) in the United States in 2003 and 2004. For 14 of the 17 quality indicators, there was no significant difference in performance between visits with vs without EHR use. Categories of these indicators included medical management of common diseases, recommended antibiotic prescribing, preventive counseling, screening tests, and avoiding potentially inappropriate medication prescribing in elderly patients. For 2 quality indicators, visits to medical practices using EHRs had significantly better performance: avoiding benzodiazepine use for patients with depression (91% vs 84%; P = .01) and avoiding routine urinalysis during general medical examinations (94% vs 91%; P = .003). For 1 quality indicator, visits to practices using EHRs had significantly worse quality: statin prescribing to patients with hypercholesterolemia (33% vs 47%; P = .01).

Statins aren't properly prescribed for patients with high cholesterol if their doctors use EHRs. I'm too lazy to go look for it, but hasn't there been some question about when it's best to use or not use statins for high cholesterol?

Apparently urinalysis is over-utilized in routine physicals if your doctor hasn't got EHRs. I can't get excited about this, urinalysis is cheap, and if you accidentally find a few cases of diabetes or kidney failure or whatever a bit earlier than you would have otherwise, how is this bad? It's not like they measured the over- or under-utilization of MRIs.

If you're taking antidepressants, you'll be safer if your doctor uses EHRs, but probably any good pharmacy would note that drug interaction problem too.



Only tangentially related... on the topic of antidepressants and their new-found popularity, I just thought I'd mention some of the reasons [that I know about] that antidepressants are prescribed. They're given to people to help them quit smoking. They're given to cancer patients. They're used in conjunction with pain relievers in pain management. Just in case you were curious.