EHRs and Diabetes Care

There is debate over how much value electronic health records will ultimately bring to the delivery of health care.  Intuitively, it would seem that they should provide a basis for good improvement in quality, particularly where multiple providers are involved in care, and should provide a basis for prompting of unaddressed items of care, especially for chronic disease patients.  The evidence to date is sketchy.  New research regarding diabetes treatment in the New England Journal of Medicine provides support for the notion that at least on some types of measurement, EHRs can support more comprehensive and theoretically better care.    (NEJM Article)

The study involved 46 practices in the Cleveland area who have been involved in a quality improvement project.  Some of the practices use EHRs and some are still paper-based.  A comparison was made in regard to performance on four process of care measures and five intermediate outcomes measures, such as cholesterol and blood pressure levels.  After adjusting for a variety of factors, the EHR-based practices showed superior performance.  On a unadjusted basis, 51% of patients at EHR locations met the process standards, compared to 7% at the paper ones; and 44% of patients met the outcome standards versus 16%.  On an adjusted basis, the difference in performance was 35% on process measures and 15% on outcomes.

It should be noted that the study does not evaluate true end improvements in patients’ health–was their health status better and were ultimate health outcomes improved?  It also may not completely isolate the effect of using an EHR from other environmental factors.  EHRs are costly to acquire and maintain, and their implementation can at least initially decrease a practice’s efficiency, so any gains in quality must be weighed against those costs, and the effects on health spending.  But this research clearly would indicate that on some measures of quality, including certain biometrics, use of EHR is correlated with strong improvements versus use of paper records.  That is an outcome we should all hope for, given the amount of money being plowed into HIT.