According to research published in the August 31st “New England Journal of Medicine” federal investments in Electronic Health Records (EHR) could reap major benefits in better patient care and health outcomes.
A study based in the Cleveland Ohio area involving more than 27,000 adults with diabetes found that those in physician practices using EHRs were significantly more likely to have healthcare and outcomes that align with accepted standards than those where doctors rely on paper records.
Improvements in care and outcomes over a three year period also proved greater among patients in EHR practices. The study’s findings remained consistent for patients regardless of insurance type, and included the uninsured as well as patients insured by Medicare, Medicaid, and commercial payers.
The research involved more than 500 primary care physicians in 46 practices partnering in a region-wide collaborative known as “Better Health Greater Cleveland” an alliance of providers, businesses, and other stakeholders dedicated to enhancing the value of care for patients with chronic medical conditions in the region. Better Health launched in 2007 is one of 16 organizations that the Robert Wood Johnson Foundation supports in their initiative, called ‘Aligning Forces for Quality”.
The Better Health study focused on a 12 month window spanning 2009 and 2010 and followed trends over a three year period. The study also measured achievements by age, gender, and racial and ethnic categories as well as language preference and estimated patient income and education.
Better Health’s locally vetted national standards for care included timely measurements of blood sugar, management of kidney problems, eye examinations, and vaccinations for pneumonia. Outcome measures included meeting national benchmarks for blood sugar, blood pressure, and cholesterol control as well as achieving non-obese Body Mass Index, and tobacco avoidance. Patients who visited the same primary care practice at least two times within a single year were included.
The study found:
• Nearly 51 percent of patients in EHR practices received care that met all of the endorsed standards as opposed to 7 percent of patients at paper-based practices receiving the same level of care. After accounting for differences in patient characteristics, EHR patients still received 35 percent more of the care standards
• Nearly 44 percent of patients in EHR practices met at least four of five outcome standards while fewer than 16 percent of patients at paper-based practices had comparable results. After accounting for patient differences, the adjusted gap was 15 percent higher for EHR practices
• EHR practices had annual improvements in care that were 10 percent greater than paper-based practices as well as 4 percent greater annual improvements in outcomes
• Patients in EHR practices showed better results, including improvements over time, in both standards of care and outcomes across all insurance categories including commercial, Medicare, Medicaid, and uninsured
“We were not surprised by these results,” said Randall D. Cebul, M.D. a Professor of Medicine at Case Western Reserve University and the study’s lead author. “The study was influenced by several factors, including our public reporting on agree-upon standards of care and the willingness of our clinical partners to share their EHR-based best practices while simultaneously competing on their execution.”
David L. Bronson, MD President of Cleveland Clinic Regional Hospitals and President-elect of the American College of Physicians, said “As the program moves forward, we expect that EHR-based sharing of information across different healthcare systems and with our patients will help keep our patients healthier and foster more discriminating use of expensive resources such as emergency departments and hospitals.”
