The effectiveness of implementing an electronic health record on diabetes care and outcomes

Abstract

Objective: To assess the impact of electronic health record (EHR) implementation on primary care diabetes care.

Data sources: Charts were abstracted semi-annually for 14,051 diabetes patients seen in 34 primary care practices in a large, fee-for-service network from January 1, 2005 to December 31, 2010. The study sample was limited to patients aged 40 years or older.

Study design: A naturalistic experiment in which GE Centricity Physician Office-EMR 2005 was rolled out over a staggered 3-year schedule.

Data collection: Chart audits were conducted using the AMA/Physician Consortium Adult Diabetes Measure set. The primary outcome was the HealthPartners' "optimal care" measure: HbA1c ≤ 8 percent; LDL cholesterol < 100 mg/dl; blood pressure < 130/80 mmHg; not smoking; and documented aspirin use in patients ≥ 40 years of age.

Principal findings: After adjusting for patient age, sex, and insulin use, patients exposed to the EHR were significantly more likely to receive "optimal care" when compared with unexposed patients (p < .001), with an estimated difference of 9.20 percent (95% CI: 6.08, 12.33) in the final year between exposed patients and patients never exposed. Components of the optimal care bundle showing positive improvement after adjustment were systolic blood pressure <80 mmHg, diastolic blood pressure <130 mmHg, aspirin prescription, and smoking cessation. Among patients exposed to EHR, all process and outcome measures except HbA1c and lipid control showed significant improvement.

Conclusion: Implementation of a commercially available EHR in primary care practice may improve diabetes care and clinical outcomes.

Figure 1

Percentage of Diabetes Patients with “Optimal Care”* Each Year, According to Whether Their Practice Ever Implemented the Electronic Health Record (EHR). Notes. &!break;*HbA1c ≤ 8 percent; LDL cholesterol < 100 mg/dl; blood pressure < 130/80 mmHg; not smoking; and documented aspirin use (for patients ≥ 40 years).

Figure 2

Percentage of Diabetes Patients with “Optimal Care”* at Practices Implementing Electronic Health Record (EHR), by Months after EHR Is Implemented, with Linear Trend. Notes.&!break;*HbA1c ≤ 8 percent; LDL cholesterol < 100 mg/dl; blood pressure < 130/80 mmHg; not smoking; and documented aspirin use (for patients ≥ 40 years).