EHRs boost adherence, monitoring in diabetics

Use of electronic health records 
improves medical outcomes among patients with diabetes, according to a recent study conducted by Kaiser Permanente.

The study, published in the Annals of Internal Medicine, found that use of EHRs was associated with improved increases in medication, monitoring and risk-factor control among patients with the disease. Researchers also found greater improvements among patients with poorer control of diabetes and cholesterol. The study included 169,711 patients with diabetes at 17 medical centers in Kaiser Permanente’s Northern California integrated care delivery system between 2004 and 2009.

“What we saw in this study is that the EHR really helped our alignment with quality measures and clinical guidelines for treatment,” Kaiser Permanente Northern California Cardiovascular Risk Reduction Program director Marc Jaffe said. “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 study found statistically significant improvements in medication increases, also known as drug-treatment intensification, in patients with HbA1C levels of 7% or greater. Ultimately, the researchers found that use of an electronic health record resulted in better HbA1C levels and levels of low-density lipoprotein or “bad” cholesterol. The study involved more than 1.37 million HbA1C tests and more than 1.27 million LDL cholesterol tests.

A previous study, published in 2010 in the journal Health Affairs, involved 35,423 Kaiser Permanente diabetes and hypertension patients in southern California and found that secure patient-physician messaging in any two-month period resulted in improvements in healthcare effectiveness measures, including improvements of between 2% and 6.5% in blood sugar, cholesterol and blood pressure screening and control.

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

EHRs have seen significant growth in recent years, spurred by financial incentives for healthcare providers who adopt them as part of the American Recovery and Reinvestment Act of 2009. Last year, 55% of physicians had adopted an electronic health record system, according to a study released in July by the Centers for Disease Control and Prevention. Electronic prescribing has likewise seen tremendous growth. According to Surescripts, 58% of office-based physicians were using e-prescribing by the end of last year, as well as 91% of retail pharmacies. In July 2012, Minnesota was ranked first in the country for use of e-prescribing in Surescripts’ seventh annual Safe-Rx Awards, with 61% of prescriptions routed electronically in the state.

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