Journal of General Internal Medicine. This paper is the latest in a recent spate of reports indicating that EHRs can help improve the quality of care.
Most studies that look at the relationship between EHRs and quality have been performed in academic medical centers and integrated delivery systems. The distinguishing characteristic of the JGIM study is that it took place in a community that had multiple health plans and predominantly small practices. "This is one of the first studies to find a positive association between EHRs and ambulatory quality in a community-based setting," the researchers noted.
The main reason why it has been difficult to do this kind of study is that health insurers are reluctant to share claims data with one another, noted Lisa Kern, MD, the lead author and an associate professor of public health and medicine at New York's Weill-Cornell Medical Center, in an interview with InformationWeek Healthcare. But the JGIM study was made possible because several health plans were willing to allow a third party to aggregate their data.
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The plans made this commitment as a result of the Hudson Valley Initiative, an effort to improve healthcare in New York's Hudson Valley. The participants in this health IT-based project include the Taconic Health Information Network and Community (THINC), the Taconic IPA, and MedAllies, a health information services provider. In 2006, the New York State Department of Health gave the Hudson Valley Initiative $5 million to subsidize the cost of EHRs, along with another grant to convene health plans in a pay-for-performance program. Five health plans agreed on a common set of quality measures, and in 2008, provided baseline quality data on physicians who belonged to the Taconic IPA.
Kern and her colleagues used this data to compare the performance of 204 primary care physicians who had adopted EHRs with that of 262 doctors who were using paper records. The researchers initially looked at data on 10 quality measures, later dropping one related to asthma because none of the doctors had at least 30 patients with asthma.
On four of the remaining nine measures--hemoglobin A1c testing in diabetes, breast cancer screening, chlamydia screening, and colorectal cancer screening--EHRs were associated with significantly higher performance. EHR users also scored higher than paper users--although not by much--on LDL testing and nephropathy testing for patients with diabetes.
When the measures were combined into a composite score, the researchers found that EHR use was linked to higher quality than paper records. But Kern cautioned that the study did not prove causality, partly because "it's possible that the doctors who used the EHRs were better doctors in other respects. Maybe they practiced medicine better for reasons that had nothing to do with the EHR. That's why we're doing additional studies over time in addition to this one to try to figure out if you can tease that issue apart."
Commenting on the JGIM study, A. John Blair III, MD, president of Taconic IPA and CEO of MedAllies, said in a statement, "Use of an EHR is a critical component of advanced primary care. As with any health IT tool, an EHR is only part of the solution and must be integrated into the practice workflow and used by the care team to advance high-quality, patient-centered care."
A number of other studies, Kern noted, have found no association between EHR usage and higher quality of care. But some new studies have suggested that there is such a correlation.
For example, a large-scale Kaiser Permanente study involving 170,000 patients found that EHRs at Kaiser facilities in Northern California were associated with a 14% reduction in HbA1c levels in patients with a baseline level above 9%. A reduction in LDL cholesterol was also seen in patients with high cholesterol when their physicians used EHRs.
Another recent study found a direct correlation between EHR use and breast exam rates. And a paper published last August showed that New York City doctors who used EHRs achieved significant improvements in eight of 10 preventive care indicators.