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EHRs significantly improve patient care, diabetes study finds


A federal incentive isn't the only reason to adopt meaningful use of electronic health records. A new study found significant improvement in diabetes treatment when practices used EHRs instead of paper records. Read more to see how patients measured up in the digital practices.

If you are still deciding whether to implement electronic health records (EHRs) in your practice, a recent study touting patient benefits may push you to go digital.

A report in the New England Journal of Medicine indicates that primary care practices using EHRs provide better care and achieve better outcomes for patients with diabetes than those that rely on paper records.

“The results support the expectation that federal support of EHRs will generate quality-related returns on our investments,” said David Blumenthal, MD, MPP, professor of medicine and healthcare policy at Harvard Medical School and past National Coordinator for Health Information Technology.

The retrospective study looked at the records of 27,000 patients with diabetes between the ages of 18 and 75 who visited one of 569 primary care physicians in 46 Cleveland-area practices at least twice from July 2009 to June 2010. The study also identified longitudinal trends by comparing the records of more than 25,000 patients from 36 sites that consistently used either electronic or paper records from July 2007 to June 2010.

In practices that used EHRs, 51% of patients received medical services that met all four endorsed standards of care (measurement of glycated hemoglobin, kidney management, eye examination, and pneumococcal vaccination) compared with fewer than 7% in paper-based practices. After adjusting for variations in patient characteristics, 35% more patients in EHR practices received all the standards of care. Looking only at safety-net practices, the difference in diabetes care was greater than 38%.

Outcomes were notably better, too. Nearly 44% of patients in EHR practices met at least four of the five standards for outcomes (glycated hemoglobin below 8%, blood pressure under 140/80mm Hg, LDL cholesterol below 100 mg/dl or use of a statin, and body mass index under 30) compared with fewer than 16% of those in practices relying on paper. On an adjusted basis, the difference was more than 15%. Outcomes at safety-net practices using EHRs were 10% better.

EHR practices also saw annual improvements in care that were 10% greater and improvements in outcomes that were 4% greater than those of paper-based practices, noted lead researcher Randall Cebul, MD. The improvements crossed all insurance statuses-uninsured, privately insured, or covered by Medicare or Medicaid.

The study was conducted by Better Health for Greater Cleveland as an outgrowth of the Robert Wood Johnson Foundation’s Aligning Forces for Quality Communities program, which encourages public reporting of performance and community-wide initiatives to improve care.

“As the program moves forward, we expect that EHR-based sharing of information across different healthcare systems, and with our patients, will help us to keep our patients healthier and foster more discriminating use of expensive resources,” said David Bronson, MD, FACP, president of Cleveland Clinic Regional Hospitals and president-elect of the American College of Physicians.

Go back to the current issue of eConsult.

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