Use of a certified electronic health record system improved drug therapy and follow-up monitoring of patients with type 2 diabetes, as well as improving their glycemic and lipid control, according to a report published online Oct. 1 in Annals of Internal Medicine.
The greatest improvements were seen in patients who had the poorest disease control at baseline, as measured by hemoglobin A1c and LDL-cholesterol levels. Electronic health record (EHR) use also reduced inappropriate medication changes and retesting of patients who already met glycemic and lipid control targets, said Mary Reed, Dr.P.H., of Kaiser Permanente Northern California, Oakland, and her associates.
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Electronic health records can greatly benefit patients with type 2 diabetes who control their disease poorly.
"[An] EHR may be a powerful tool to help clinicians deliver well-targeted, high-quality chronic disease care and improve patient outcomes," they noted.
Implementation of EHR systems is being driven by federal stimulus legislation that provides incentive payments of up to $44,000 per physician for the "meaningful use" of such a system; penalties for not doing so begin in 2015.
Dr. Reed and her colleagues were able to compare patient outcomes before and after EHR adoption because of the staggered roll-out of the technology across the 17 medical centers of their HMO over 3 years.
The investigators examined testing intervals, glycemic control, and LDL-cholesterol control in the 169,711 patients in their plan’s diabetes registry during the 5 years before, during, and after EHR implementation. There were more than 1.3 million HbA1c tests and 1.2 million LDL cholesterol tests during that time.
After EHR implementation, patients with an HbA1c levels of 7% or greater were significantly more likely to receive treatment intensification than they had been before the EHR was used. In contrast, patients with HbA1c values under 7% did not experience unnecessary intensification.
Similarly, after implementation, patients with high HbA1c levels were significantly more likely to undergo retesting within 90 days than they had been before, while those with normal HbA1c levels were not subjected to unnecessary retesting.
The findings were the same with regard to high LDL-cholesterol levels. Diabetic patients with high LDL were more likely to receive treatment intensification and to be retested within 90 days than they had been before the EHR program was implemented.
Correspondingly, both glycemic control and cholesterol control improved with use of the EHR and the improvement in these clinical outcomes was greatest among patients whose HbA1c and LDL-cholesterol levels had been the highest at baseline, Dr. Reed and her associates said (Ann. Intern. Med. 2012;157:482-9).
Improvements were characterized as "modest," but the investigators noted that could be due in part to the fact that this patient population was already participating in "a sophisticated and systematic [diabetes] management program" and therefore had good control at baseline.
"It is likely that EHR implementation could bring more dramatic improvements in other settings, where baseline rates of control are lower or disease management capabilities are more limited," they said.
They added that as an observational study, their study could not establish cause and effect. But the findings do suggest that using an EHR improves the clinical care of patients with diabetes, they said.
"The lack of any measurable unintended harm in the outcomes for this study" is also an important finding, because it refutes the results of previous studies that suggested an EHR could have no effect on, or could even worsen, patient care.
The study was funded by the National Institute of Diabetes and Digestive and Kidney Diseases.