Impact of an Electronic Medical Record on Diabetes Quality of Care

Abstract

PURPOSE This study was designed to evaluate the impact of electronic medical record (EMR) implementation on quality of diabetes care. METHODSWe conducted a 5-year longitudinal study of 122 adults with diabetes mellitus at an intervention (EMR) clinic and a comparison (non-EMR) clinic. Clinics had similarly trained primary care physicians, similar patient populations, and used a common diabetes care guideline that emphasized the importance of glucose control. The EMR provided basic decision support, including prompts and reminders for diabetes care. Preintervention and postintervention frequency of testing for glycated hemoglobin (HbA 1c ) and low-density lipoprotein (LDL) levels were compared with and without adjustment for patient age, sex, comorbidity, and baseline HbA 1c level. RESULTSFrequency of HbA 1c tests increased at the EMR clinic compared with the frequency at the non-EMR clinic (P <.001). HbA 1c levels improved in both clinics (P <.05) with no signifi cant differences between clinics 2 years (P = .10) or 4 years (P = .27) after EMR implementation. Similar results were observed for LDL levels.CONCLUSIONS In this controlled study, EMR use led to an increased number of HbA 1c and LDL tests but not to better metabolic control. If EMRs are to fulfi ll their promise as care improvement tools, improved implementation strategies and more sophisticated clinical decision support may be needed. INTRODUCTIONQ uality of outpatient diabetes care lags behind evidence-based care recommendations, 1,2 and various strategies have been suggested to improve care. [3][4][5][6][7] Electronic medical records (EMRs) have been proposed as an effective information management tool with the potential to improve diabetes care, [8][9][10] and an Institute of Medicine report has identifi ed key features of EMRs that may lead to better care. 10 Currently available outpatient EMRs can identify patients with diabetes, assess whether the patient is due for recommended tests or screening procedures, and determine which patients have not achieved evidence-based clinical goals for glycemic, lipid, or blood pressure control. This information is typically presented to the clinician as reminders (patient due for a glycated hemoglobin [HbA 1c ] test) or prompts (patient's HbA 1c level is above recommended level) delivered electronically at the point of care. Current diabetes care is characterized by high rates of clinical inertia, defi ned as failure to intensify treatment in patients who have not achieved evidence-based clinical goals.11,12 Rates of clinical inertia at diabetes visits exceed 50%, and EMR technology seems well-suited to reducing this problem, thus improving care.Currently only about 20% of primary care physicians report use of EMRs. Because of the well-established administrative and fi nancial management advantages of EMRs and the pressure from payers, purchasers, and regulators of health care to use EMRs, investments in such technology are 17 In controlled studies, current EMR systems have had limited positive imp...

The Medical Home: Growing Evidence to Support a New Approach to Primary Care

“…102 At 5 years, practices with electronic records document more frequent testing of glycosylated hemoglobins and lipid levels but do not achieve better control. 103 High quality primary care groups find having an electronic medical record a useful tool but not essential to meeting guidelines. 104 • Practices go through a voluntary recognition process by an appropriate nongovernmental entity to demonstrate that they have the capabilities to provide patient centered services consistent with the medical home model.…”

Bruk av skjema i oppfølgingen av diabetes i allmennpraksis

“…Mulighetene for bearbeiding av registrerte pasientdata varierte. Dette kunne vaere funksjoner som automatiske påminnelser til pasienten (18), påminnelser om innkalling til time (13,16,18), forslag om endringer i medisinering (14,18,20) og tilbakemelding om registrerte data for pasienten eller legepraksisen sammenliknet med andre (13,14,19). Inkluderte studier (n = 7)…”

How Can Practice-based Research Contribute to the Elimination of Health Disparities?

“…[32][33][34][35] It also will mean using the power of information systems to improve direct patient care (but more than just electronic prompts or reminders). 36 The frequency of "missed opportunities" in primary care visits is embarrassingly high for disparities-relevant services such as giving adult immunizations, diagnosing depression, or intensifying the regimens of patients with partially controlled hypertension or diabetes. The key is to make good care automatic.…”