Study finds EHRs improve care in ambulatory care practices

Use of electronic health records (EHRs) by physicians with ambulatory care practices in New York's Hudson Valley improved patient care compared with those who used paper records, according to a study published online October 3 in the Journal of General Internal Medicine.

Patients whose physicians used EHRs provided significantly better quality of care than physicians using paper records for breast cancer screening, chlamydia screening, colorectal cancer screening, and diabetes-related hemoglobin testing, the study researchers found. The findings come amid a political furor over the effectiveness of the federal government's effort to stimulate healthcare IT adoption through "meaningful use" incentive payments.

The study took place in a community that was focusing efforts for physician practices to implement EHRs for their ambulatory patients, and was conducted by researchers at Weill Cornell Medical College and the Health Information Technology Evaluation Collaborative (HITEC). The study's objective was to evaluate and assess the impact of New York's health IT strategy in its early adoption stages.

The quality-of-care measures related to common treatments and monitoring, including tests and treatment for patients with chronic medical conditions (asthma and diabetes), treatments for children with pharyngitis or upper respiratory infections, test for sexually transmitted diseases, and screening for breast and colon cancers.

The team used the database of the Taconic Health Information Network and Community (THINC), a nonprofit organization working to improve healthcare quality in the seven counties comprising the Hudson Valley north of New York City. Of the 3,548 family medicine physicians, internists, and pediatricians who practiced in this region, 932 had quality data for analysis. Physicians were selected if they had recorded at least one of the quality measures being analyzed for more than 30 patients.

A total of 466 physicians with records for 74,618 patients qualified. Of these, 44% of the physicians were using EHRs of at least five different software systems; the others were using paper records, according to lead investigator Dr. Lisa M. Kern, an associate professor of public health and medicine at Weill Cornell Medical College.

The research team determined that the early adopters of EHRs were more likely to be younger (median age 52), have a larger practice size, and already be using practice management software. Gender, specialty, urban versus suburban versus rural location, or case mix had no impact on whether electronic or paper records were being used.

The quality measures that showed significantly higher performance when electronic records were used were for chlamydia screening (65.8% for EHR versus 53.0% for paper), diabetes-related hemoglobin testing (90.1% versus 84.2%), breast cancer screening (78.6% versus 74.2%), and colorectal cancer screening (51.3% versus 48.0%).

"This study starts to grow the evidence that the use of electronic systems can systematically improve the quality of care," said senior investigator Dr. Rainu Kaushal, a professor of medical informatics at Weill Cornell Medical College and director of the Center for Healthcare Informatics and Policy. "The findings of this study lend support to the very significant investments in health information technology that are being made by the federal government, states, and healthcare providers."

The authors noted that prior studies on the effects of EHR use in the outpatient setting have been mixed. The study's focus on a mix of ambulatory care physicians using off-the-shelf software and paper-based records increases the generalizability of its findings, Kern said.

Those findings may be raised by supporters of healthcare IT, who are defending the Obama administration's meaningful use program in the wake of a letter written by Republican congressional representatives to the Department of Health and Human Services. The letter said that despite an investment of more than $10 billion, the U.S. is no closer to the long-term goal of healthcare records interoperability, and that stimulus payments should be suspended.

Future research by the Weill team will be to determine how the effects of EHRs on patient care vary over time and across different locations in New York, examine the effects of EHRs on the cost of patient care, and work on improving ways to measure the quality of patient care.

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