Electronic Health Records Improve Care for Type 2 Diabetes Patients

According to the study co-leader, Jeph Herrin, Ph.D., of Yale University, with the U.S Department of Health and Human Services currently offering incentives for medical practices to move their records to electronic systems -- and Medicare payment penalties to those who don't convert by 2015 -- doctors and hospitals are increasingly incorporating these tools into their practices. However, the notion that electronic health records can improve care measurably has been under significant debate.

"What's unknown is whether moving to an electronic health records system would actually improve health outcomes," he said. "So far, different studies have shown different results."

Seeking more evidence, Herrin, co-author David Ballard, M.D., Ph.D., and their colleagues took advantage of two concurrent initiatives at the HealthTexas Provider Network. The first is a long-term effort made by the group to collect health data on their diabetes patients. The second is the roll out, started in 2006, of an electronic health record system to the Network's nearly 100 clinics.

Herrin and his colleagues followed 14,051 diabetes patients from 34 group clinics over a four-year period. They looked at optimal diabetes care as a whole as well as individually examining each of five measures of diabetes management: HbA1c, LDL cholesterol, diastolic blood pressure, systolic blood pressure, aspirin prescription and non-smoking status.

They report that over the rollout period, the 29 practices that had the electronic health record system saw 6,376 diabetic patients. Comparing those exposed to the system to those that were not, the researchers found a significant improvement in all of the variables except for HbA1c and LDL cholesterol in the electronic health records group.

Herrin explained that certain features of the electronic health record system might be responsible for the better health measures among patients whose doctors used it. For example, even if patients visited their physician for something unrelated to diabetes -- such as a flu shot -- the system reminded their doctor to ask questions related to diabetes care. The researchers also noted that part of the increase might be due to better documentation in electronic health records than in paper records.

"This study offers evidence and reassurance that switching to electronic medical records isn't going to hurt patients and may in fact help them," Herrin said.

According to Spyrois Mezitis, M.D. in New York City, doctors and electronic health records still have a long way to go. "This study showed mixed results," he said. "There's much room for improvement here." Dr. Mezitis pointed out that measures for HbA1c and LDL cholesterol, two very important elements in diabetes care, did not improve in this study in the electronic health records group. With the extra initial expense, time and effort it takes to set up electronic health records, he added, more research is needed to develop systems that improve all measures of diabetes care.

• Switching from paper records to electronic records does not adversely affect the care of patients with type 2 diabetes older than 40, according to a new study in Health Services Research.
• Patients older than 40 with type 2 diabetes at a clinic that uses electronic records are more likely to meet blood pressure target levels, refrain from smoking and take aspirin daily than patients at clinics that continue to use paper records.
• Switching to electronic records might not help patients older than 40 with type 2 diabetes to control their cholesterol levels or improve their HbA1c levels.

Health Services Research, Jan. 2012