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Electronic Health Records Aid in Diabetes Care

DOR researchers found that the use of electronic health records at 17 Northern California medical centers was associated with significant improvements in diabetes care and outcomes.

Published in the Annals of Internal Medicine, the study demonstrated that electronic health records helped clinicians to better target treatment changes and follow-up testing for their diabetes patients.

“The EHR really helped our alignment with quality measures and clinical guidelines for treatment,” said Marc Jaffe, MD, clinical leader, Kaiser Permanente Northern California Cardiovascular Risk Reduction Program, and a co-author of the study. “Increases in information availability, decision support and order-entry functionality help clinicians to identify the most appropriate patients for drug-treatment intensification and retesting, which leads to better care of patients with diabetes.”

The federal government is currently providing financial incentives totaling $29 billion for hospitals and physicians to adopt certified electronic health records, and will begin penalizing medical institutions that have not adopted them by 2015. This new mandate has been somewhat controversial within the medical community and has generated national media interest.

Between 2005 and 2010, Kaiser Permanente Northern California implemented Kaiser Permanente HealthConnect® in 17 hospitals and 45 medical office buildings. The staggered rollout provided a unique opportunity to compare diabetes care before and afterward in a large population of nearly 167,000 diabetes mellitus patients.

The DOR research was the first to analyze the effect of electronic health records on indicators of disease severity in a large population of patients with diabetes using a rigorous study design to account for changes in diabetes care over time.

The study found statistically significant improvements in drug-treatment intensification in patients with blood glucose (HbA1c) values of 7 percent or greater and increases in guideline-recommended follow-up testing for patients who had elevated lab results.

Researchers adjusted for patient characteristics, medical center, time trends and facility-level clustering. During the study period (2004 to 2009), patients had a total of 1,372,735 HbA1c and 1,268,086 low-density lipoprotein cholesterol (LDL-C) tests.

Ultimately, use of electronic health records was associated with improved overall HbA1c and LDL-C levels among all patients, according to Mary Reed, DrPH, staff scientist with the Kaiser Permanente Northern California Division of Research and lead author of the study.

“Our next step is to see how EHR use improves downstream clinical events in patients with diabetes,” Reed said. “Since we have found that glycemic control and lipid levels were better, now we need to better understand if EHR use affects measurable events like emergency room visits. This would be an important next step in evaluation of the impact and potential value of electronic health records.”

The research was featured in 127 media outlets including Forbes, InformationWeek Healthcare, eWeek, FierceHealth IT and HealthTechZone, and received positive chatter on Twitter with approximately 187 unique tweets and more than 260,000 impressions.

Additional authors on the study include Jie Huang, PhD, and Ilana Graetz, with the Kaiser Permanente Northern California Division of Research; Richard Brand, PhD, with the University of California, San Francisco; John Hsu, MD, MBA, MSCE, with Massachusetts General Hospital, Boston; and Bruce Fireman, MA, with the Kaiser Permanente Northern California Division of Research. The National Institute of Diabetes and Digestive and Kidney Diseases funded the study.

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