Physicians who use EHRs are more likely to identify diabetic patients who need more intense drug treatment, according to a study from Kaiser Permanente. Similarly, EHR use was linked to better management of disease risk factors and greater improvements among patients with poor control of their diabetes and lipid levels.

The study, which appears in the current issue of Annals of Internal Medicine, is the first to demonstrate how EHRs aid clinicians in better targeting treatment changes and follow-up testing for diabetic patients.

This study showed that "EHRs really helped our alignment with quality measures and clinical guidelines for treatment," said Marc Jaffe, clinical leader at Kaiser Permanente Northern California cardiovascular risk reduction program.

Jaffe went on to explain, "Increases in information availability, decision support, and order-entry functionality help clinicians to identify the most appropriate patients for drug-treatment intensification and retesting, which leads to better care of patients with diabetes."

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Mary Reed, research scientist at the Kaiser Permanente Northern California division of research, said the team looked at "three tightly linked steps" in the care of diabetic patients: whether or not the patient received medication treatment intensifications, whether or not he underwent follow-up testing, and whether or not a patient's blood sugar or lipid levels were affected by the EHR.

"All three times, we saw the EHR was associated with significant improvements. Patients who had high hemoglobin [A1c] or LDL levels, meaning they had high blood sugar or high cholesterol levels, were more likely to have the medication treatment intensification if the provider was using an EHR." The same can be said with patient follow-up testing, she added. "... [I]t's the first large, rigorously designed study that shows EHRs are improving patient health, and patients are truly benefiting from these."

The study included 169,711 patients with diabetes. Researchers used a quasi-experimental design that took advantage of outpatient EHR implementation across 17 medical centers in Kaiser Permanente's Northern California system. The system implemented Kaiser Permanente HealthConnect in the hospitals and 45 medical office buildings between 2005 and 2010.

"What Kaiser did, completely unrelated to the study, was a staggered roll out schedule for the EHR implementation," said Reed. "They sequentially rolled out the EHR at one medical center after the other, across all 17." This allowed Reed and her team to compare "pre and post" patient data at every medical center. "Because of the staggered nature, we were able to look at changes over time," she said.

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