Among patients with diabetes, use of an outpatient electronic health record (EHR) in an integrated healthcare delivery system was associated with modest reductions in emergency department visits and hospitalizations, but was not associated with a change in office visit rates, according to a study in the September 11 issue of JAMA.
The Health Information Technology for Economic and Clinical Health (HITECH) Act authorizes up to $27 billion during 10 years to promote meaningful use of EHRs, with penalties for lack of EHR use beginning in 2015. With these substantial incentives, it is not surprising that EHR adoption in the United States appears to be increasing. Electronic health records increase access to timely and complete patient information at the point of care, with potential to improve the quality and efficiency of care delivered, including improved care coordination, according to background information in the article. "With medical care for patients with chronic diseases representing 75 percent of U.S. health care costs and hospitalizations representing one-third of all U.S. health care expenditures, better management of chronic medi¬cal conditions such as diabetes represents one clinical area in which improved care theoretically could reduce spending. There is, however, limited and mixed evidence on the effect of EHRs on health outcomes or clinical events."
Staggered EHR implementation across outpatient clinics in an integrated delivery system, Kaiser Permanente Northern California, between 2005 and 2008 created an opportunity for studying changes associated with EHR use. Mary Reed, Dr.P.H., of Kaiser Permanente Northern California, Oakland, and colleagues examined the association between EHR implementation and emergency department (ED) visits, hospitalizations, and office visits among patients with diabetes between 2004 and 2009, seen at 45 facilities in 17 medical centers. The study included all 169,711 patients in the health plan's clinical diabetes registry at the beginning of the study period.
The researchers found that after use of the EHR, there were fewer ED visits (a relative 5.5 percent decline from the average predicted baseline rate); hospitalizations decreased overall (a relative 5.2 percent decline from the predicted baseline average rate); and fewer nonelective hospitalizations (a relative 6.1 percent difference from the predicted baseline average rate). Hospitalizations specifically for ambulatory care-sensitive conditions also declined with EHR use (a 10.50 percent difference).
There was no statistically significant difference in office visit rates with the implementation of an EHR.
"Further studies are needed to quantify the association of EHR use with changes in costs," the authors conclude.