Mary Reed, DrPH, a researcher at Kaiser Permanente Northern California in Oakland, and her colleagues found improvements in multiple clinical measures after EHR implementation, particularly among patients with less well-controlled glucose and lipid levels.
"We found that EHR use was associated with improved rates of medication treatment intensification, follow-up monitoring, and glycemic and lipid control in patients with diabetes."
This is the first study of a large outpatient diabetic population to assess the effect of a complete and certified EHR system. The federal government has established financial incentives, totaling $29 billion, to encourage EHR uptake and "meaningful use," yet little longitudinal data are available regarding the clinical value of EHRs, according to the authors.
The researchers identified 169,711 patients in the Kaiser Permanente diabetes registry at the end of 2003. As Kaiser rolled out a commercially available EHR system (EpicCare, Epic Systems) between 2004 and 2009, 129,433 patients had 972,115 hemoglobin A1c (HbA1c) tests and another 151,838 had 1,095,991 low-density lipoprotein (LDL) cholesterol assays.
The EHR system was associated with treatment intensification among patients with elevated HbA1c levels. Participants with levels of 9% or greater experienced an increase in treatment intensification associated with EHR use (odds ratio [OR], 1.10 [95% confidence interval (CI), 1.05 to 1.15]), as did those with values of 7% to 8.9% (OR, 1.12 [CI, 1.06 to 1.18]). Both findings were statistically significant (P < .001) in a multivariate analysis adjusting for calendar month and year, medical center, and patient characteristics. In contrast, the researchers saw no change among patients with HbA1c values below 7% (OR, 0.98 [CI, 0.94 to 1.02]; P = .29).
EHR implementation was also associated with statistically significant treatment intensification for patients with LDL cholesterol values between 100 and 129 mg/dL (OR, 1.06 [CI, 1.00 to 1.12]; P = .036). However, there was no statistically significant change associated with EHR implementation among patients with LDL cholesterol values of 130 mg/dL or greater (OR, 0.97 [CI, 0.91 to 1.04]; P = .46). There was a statistically significant reduced likelihood of treatment intensification in patients with cholesterol values of 100 mg/dL or lower (OR, 0.88 [CI, 0.82 to 0.94]).
Three additional clinical benefits were associated with EHR implementation in multivariate analyses. A statistically increased likelihood of patients having a follow-up test within 1 year was observed for all patients (P < .050). At the same time, patients with an index test indicating good control were less likely to undergo retesting within 90 days (P < .005), potentially signaling more appropriate use of resources. In contrast, for patients with elevated HbA1c or LDL cholesterol levels, the EHR was associated with a faster rate of retesting overall (P < .001), compared with a period before EHR adoption.
"Overall, our study suggests that the EHR may be a powerful tool to help clinicians deliver well-targeted, high-quality chronic disease care and improve patient outcomes," the authors write.
Ann Intern Med. 2012;157:482-489.