OAKLAND, Calif. — The implementation of electronic health records (EHRs) in a large, integrated, health care delivery system resulted in significant decreases in the numbers of emergency room visits and hospitalizations for diabetes patients, according to a study published today in the Journal of the American Medical Association (JAMA).
The study is the first to show a reduction in unfavorable clinical events due to the implementation of electronic health records.
"Using the electronic health record in the outpatient setting improved the quality of care in ways that cumulatively resulted in fewer negative events," said Mary Reed, DrPH, staff scientist with the Kaiser Permanente Division of Research in Oakland, Calif., and the study's lead author.
Extensive electronic health records were implemented in 17 medical centers across Kaiser Permanente's Northern California region between 2005 and 2008. The sample included 169,711 patients with diabetes over 1 year old in the Kaiser Permanente diabetes clinical registry between 2004 and 2009.
Annual emergency room visits declined 5.5%, from 519 visits per 1,000 diabetes patients before electronic health records, to 490 visits per 1,000 diabetes patients afterward. Annual hospitalizations declined 5.2%, from 239 per 1,000 diabetes patients before electronic health records to 252 per 1,000 diabetes patients afterward. The researchers did not find any significant change in the number of office visits for patients with diabetes before and after electronic health records were implemented.
"Since our study finds EHR-related improvement in care quality and outcomes without changes in office visit rates, this may reflect greater efficiency during visits or care delivery between visits," Reed and co-authors wrote in the JAMA article.
The use of electronic health records is increasing nationally: The Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 authorized up to $27 billion in federal payments over 10 years to promote the use of electronic health records, with penalties beginning in 2015 for medical practices that do not use them.
Kaiser Permanente's federally certified, complete outpatient electronic health record is in use for all of the system's 9.1 million members in nine states and the District of Columbia. The system provides integrated clinical information at the point of care, with computer-based physician prescription ordering, decision-support for lab testing and treatment intensification, and secure e-mail messaging capability.
A 2012 study by Reed et al. published in the Annals of Internal Medicine found that use of the electronic health records was associated with improved blood glucose levels, treatment intensification and monitoring of Kaiser Permanente's diabetes patients in Northern California.
"These studies demonstrate that when doctors and patients use an electronic health record, good things happen," said Marc Jaffe, MD, a study co-author and Kaiser Permanente endocrinologist in South San Francisco. "The current study adds to our understanding by describing how it can help doctors keep patients healthy when used part of an integrated care delivery system."
In addition to Reed, co-authors of the study were: Jie Huang, PhD, Ilana Graetz, PhD, Romain Neugebauer, PhD, Bruce Fireman, MA, of the Kaiser Permanente Division of Research; Richard Brand, PhD, of the Department of Epidemiology and Biostatistics, University of California, San Francisco; Marc Jaffe, MD, Department of Medicine and Endocrinology, The Permanente Medical Group, South San Francisco; Dustin W. Ballard, MD, MBE, Department of Emergency Medicine, The Permanente Medical Group, San Rafael, Calif.; and John Hsu, Massachusetts General Hospital, Harvard Medical School, Boston, Mass.
The study was funded by the National Institute of Diabetes and Digestive and Kidney Diseases and the Agency for Healthcare Research and Quality.