The Effectiveness of Implementing an Electronic Health Record on Diabetes Care and Outcomes
Article first published online: 17 JAN 2012
© Health Research and Educational Trust
Health Services Research
Volume 47, Issue 4, pages 1522–1540, August 2012
How to Cite
Herrin, J., da Graca, B., Nicewander, D., Fullerton, C., Aponte, P., Stanek, G., Cowling, T., Collinsworth, A., Fleming, N. S. and Ballard, D. J. (2012), The Effectiveness of Implementing an Electronic Health Record on Diabetes Care and Outcomes. Health Services Research, 47: 1522–1540. doi: 10.1111/j.1475-6773.2011.01370.x
- Issue published online: 5 JUL 2012
- Article first published online: 17 JAN 2012
- American Diabetes Association. Grant Number: 1-09-CR-05
- Agency for Healthcare Research and Quality. Grant Number: AHRQ 1R21HS020696-01
- Electronic health records;
- quality of care
To assess the impact of electronic health record (EHR) implementation on primary care diabetes care.
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.
A naturalistic experiment in which GE Centricity Physician Office–EMR 2005 was rolled out over a staggered 3-year schedule.
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.
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.
Implementation of a commercially available EHR in primary care practice may improve diabetes care and clinical outcomes.