Electronic Health Records and Ambulatory Quality of Care

In a New York study of 466 providers (most in small practices) and 74,618 patients published in the  Journal of General Internal Medicine,  they found "a positive association between the 44% who used EHRs and ambulatory quality in a community-based setting" compared to those using paper records

FULL STUDY . 

Although the study claims that those using an EHR saw "significantly higher quality of care for four of the measures: hemoglobin A1c testing in diabetes, breast cancer screening, chlamydia screening, and colorectal cancer screening" The  effect sizes only ranged from 3 to 13 percentage points per measure."
 
Electronic health record use was associated with higher performance than paper for: hemoglobin A1c testing in diabetes (90.1 % vs. 84.2 %, p = 0.003), breast cancer screening (78.6 % vs. 74.2 %, p < 0.001), chlamydia screening (65.8 % vs. 53.0 %, p = 0.02) and colorectal cancer screening (51.3 % vs. 48.0 %, p  = 0.01). Electronic health record use was associated with higher quality for two other measures, though these were not statistically significant: LDL testing in diabetes (87.6 % vs. 85.1 %, p = 0.26) and nephropathy screening in diabetes (68.2 % vs. 64.8 %, p = 0.33).

 Abstract

CONTEXT  

The US Federal Government is investing up to $29 billion in incentives for meaningful use of electronic health records (EHRs). However, the effect of EHRs on ambulatory quality is unclear, with several large studies finding no effect.

OBJECTIVE  

To determine the effect of EHRs on ambulatory quality in a community-based setting.

DESIGN  

Cross-sectional study, using data from 2008.

SETTING  

Ambulatory practices in the Hudson Valley of New York, with a median practice size of four physicians.

PARTICIPANTS  

We included all general internists, pediatricians and family medicine physicians who: were members of the Taconic Independent Practice Association, had patients in a data set of claims aggregated across five health plans, and had at least 30 patients per measure for at least one of nine quality measures selected by the health plans.

IINTERVENTION  

Adoption of an EHR.

MAIN OUTCOME MEASURES  

We compared physicians using EHRs to physicians using paper on performance for each of the nine quality measures, using t-tests. We also created a composite quality score by standardizing performance against a national benchmark and averaging standardized performance across measures. We used generalized estimation equations, adjusting for nine physician characteristics.

KEY RESULTS  

We included 466 physicians and 74,618 unique patients. Of the physicians, 204 (44 %) had adopted EHRs and 262 (56 %) were using paper. Electronic health record use was associated with significantly higher quality of care for four of the measures: hemoglobin A1c testing in diabetes, breast cancer screening, chlamydia screening, and colorectal cancer screening. Effect sizes ranged from 3 to 13 percentage points per measure. When all nine measures were combined into a composite, EHR use was associated with higher quality of care (sd 0.4, p = 0.008).

CONCLUSIONS  

This is one of the first studies to find a positive association between EHRs and ambulatory quality in a community-based setting.