Does the use of electronic medical records improve surrogate patient outcomes in outpatient settings?

We reviewed the evidence regarding the effectiveness of electronic medical records (EMRs) as tools for improving surrogate patient outcomes in the outpatient primary care setting.

We searched the MEDLINE database (1966-1999) to find relevant articles for inclusion in the systematic review. Reference lists of retrieved publications were also searched for relevant citations. We included original published reports of all prospective studies evaluating the use of hybrid or complete EMR systems as a method of improving surrogate patient outcomes in the outpatient primary care setting. Criteria for evaluation included the use of a random study group assignment, appropriateness of control group, blinded assessment of outcomes, number and reasons for withdrawal of subjects, and attempts to minimize confounding interventions.

Seven prospective trials of complete EMRs and 9 prospective trials of hybrid EMRs were located. Most evaluated the impact of EMR-generated reminders on provider and patient compliance with health maintenance interventions. Findings were equally positive for both complete and hybrid EMRs, and all but 1 trial reported positive results. However, the methodologic quality of the trials was modest. Design problems included lack of concurrent control groups, non-blinded outcome assessment, and the presence of potentially confounding concurrent interventions.

Evidence from published trials suggests that utilization of either complete or hybrid EMRs can improve some surrogate outpatient care outcomes. However, rigorous trials that evaluate their impact on morbidity and mortality, and employ current technologies are required before widespread adoption of EMRs can be confidently recommended.