The study in the July issue of Health Affairs looked at the results of surveys given to 163 doctors in three Massachusetts communities. These physicians were among those who received free EHRs and access to health information exchanges in a $50 million pilot program funded by Blue Cross Blue Shield of Massachusetts. The Massachusetts eHealth Collaborative, which administered the pilot from 2006-2008, also provided the practices with technical assistance, which of course is not the case for most community physicians who adopt EHRs.
To measure the impact of such assistance, the participants were invited to complete surveys in 2005, before the pilot, and in 2009, after the test ended. The study group included the physicians who filled out both questionnaires.
The surveys asked the physicians whether they could create lists of patients by diagnosis or health risk, by their laboratory results, and by the medications they take. The researchers discovered that the ability to create registries based on lab results and medications increased significantly after the doctors had EHRs. Whereas 44% could generate a lab results registry in 2005, that number jumped to 77% by 2009. Thirty-three percent of respondents could build a medication registry before the pilot; afterwards, it went up to 83%.
The researchers found a correlation between the size of the practice and the ability to generate registries. And physicians who used more of an EHR's functions were more likely to use registries in patient care. Specialists were more likely to be able to generate lab registries, while primary care doctors had a greater ability to build medication registries.
In the final analysis, the researchers concluded that greater use of EHRs is "consistent with" a greater ability to create registries. But at least one expert questions whether the results apply in the real world.
"Most of today's EHRs can do a registry-like function, but it takes work to do that," notes Jane Metzger, a CSC consultant who is expert in registries. "Not every practice that adopts an EHR is committed to care management--having guidelines for care, knowing who your diabetic patients are, and deciding you should see them at least once a year and so forth.
"Practices with EHRs have a problem list, but they have to keep it up to date. And an EHR doesn't automatically tell you who the active patients are. The EHR will have a way to record that this isn't a regular patient, but it's extra work to do it."
Most EHRs today can generate letters, postcards, or call lists so that practices can contact certain types of patients, such as diabetics who haven't been in for their annual check or haven't had an HbA1c test for more than six months, notes Metzger. But that still takes work and subtracts time from busy staff members who have many other duties.
Whether or not physicians use registries depends to a great degree on "whether a practice is committed to doing team-based care management," Metzger says. "If they're not, they're not interested in registries, and they won't be working to keep a clean patient list and have the data they need."
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