Electronic Health Records and the Evolution of Diabetes Care

Abstract

As the prevalence of diabetes approaches 10% in the United States and with an annual cost of over $240 billion, improving the quality of diabetes care through meaningful uses of technology is a national health priority. 5 We are now entering an exciting time in diabetes management as electronic health record (EHR) innovations open up new possibilities for the use of health IT in the primary care of patients with type 2 diabetes. Understanding the successes and unintended consequences of EHRs on the quality of diabetes care can help identify tools and strategies that health care organizations can leverage to improve patient outcomes. In this article, we review a selection of informative studies that demonstrate the impact of EHRs on the quality of diabetes care to date and that illustrate future directions for how EHRs might improve the care of patients with diabetes. IntroductionFor this narrative review, we selected leading articles published over the past decade that examined the clinical impact of EHRs on diabetes care. This review is organized into the following sections: (1) impact of the initial adoption of basic EHRs (including care reminders and registries), (2) newer innovative health IT tools that leverage an underlying EHR infrastructure (eg, secure messaging, online coaching, patient portals), and (3) potential next steps and future avenues of health IT use on quality of diabetes care. Rather than a formal evidence-based summary of the literature, our goal is to provide a conceptual framework for how EHRs-and innovations leveraging EHRs-can be adapted to improve the outpatient care of patients with type 2 diabetes. The reader is referred elsewhere for reviews of technology focused on blood glucose monitoring, 6 in-patient diabetes care, 7 or artificial pancreas.8 Research articles were drawn primarily from the English language literature and were evaluated by the authors with regard to quality, timeliness, and relevance. Studies with rigorous methodology were preferred, with randomized controlled trials (RCTs, n = 9), large prospective cohort studies (n = 8), and systematic reviews (n = 3) having highest priority. Basic EHR Implementation and the Quality of Diabetes CareSeveral observational studies of the effects of EHRs on large diabetic patient populations have shown significant improvements in quality as measured through reduced hospitalization, 1 The goals of the HITECH act were not only to incentivize the adoption of EHRs, but also to increase the quality, safety, and efficiency of health care by promoting the concept of "meaningful use." 2,3 The stepwise implementation of "meaningful use" is now entering the latter stages with a focus on improving patient outcomes.4

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