Do EHRs Improve Diabetes Care?

5 Key Elements For Clinical Decision Support Systems

Diabetes patients whose medical records were stored in an electronic health record (EHR) didn't receive better care those whose medical records were still paper-based. So says a three-year study published in the May/June issue of the Annals of Family Medicine. The study examined data on 798 type 2 diabetes patient records, collected from 16 EHR-using primary care practices and 26 practices not using EHRs.

Researchers did not find that EHRs were linked to better adherence to diabetes guidelines. Moreover, patients in practices using paper records were more likely to meet all of the three intermediate outcome targets for blood sugar, blood pressure, and cholesterol levels. The investigators completed their initial assessment of all paper or electronic records in 2004 and then conducted follow-up assessments in 2005 and 2006.

In an interview, study lead author Jesse Crosson explained that, while they conducted their research before the federal government's EHR incentives program, EHR vendors have not made adequate changes to the technology that help physicians improve clinical decision support (CDS) or population management. Crosson suspects that if researchers conducted the same EHR study with products currently on the market they might still see the same results.

"Clinical decision support tools and population management features are not well developed even in current EHRs, so the problems that underlie what we were looking at in the study persist today," Crosson said. "I'm involved in other studies where we are looking at practices and their EHRs as they are being used now and there has been some improvement, but many of these issues have not been addressed."

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Crosson also believes EHRs should have alerts that tell clinicians, during the patient encounter, about important screenings to perform or reminders regarding the intensification of medication therapies.

He also said primary care practices must shift from focusing on individual patients to groups of patients so that they can, for example, target those who don't take their medications or keep their medical appointments.

According to the report, the effective use of CDS and population health management functions is likely not widespread even among established users of EHR technology.

Because many of these primary care practices lack IT staff and an adequate number of clinical employees, the report suggests that Regional Extension Centers, which support small physician practices that are implementing EHR technology, should help them more effectively use the technology to proactively address population health.

The report's authors also said: "Our findings show that even after the potentially disruptive phase of initial EHR implementation, quality improvements remain elusive. Achieving truly meaningful use of this technology will require more than time and experience: it will require recognition that, until population health is improved, use does not equal success."

The report's results are in stark contrast to recent research that found EHRs did improve diabetes treatment. One such study, published recently in the New England Journal of Medicine, showed that EHR-based physician practices improved treatment when compared with practices that relied on paper-based records. Those researchers examined data on 27,207 adults with diabetes from July 2009 through June 2010.

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