Among patients with diabetes, use of an outpatient electronic health record in an integrated healthcare delivery system was associated with modest reductions in ED visits and hospitalizations, but was not associated with a change in office visit rates, according to a study.
The Health Information Technology for Economic and Clinical Health 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, that EHR adoption in the U.S. appears to be increasing is not surprising, study authors wrote in the Sept. 11 issue of the Journal of the American Medical Association.
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, the researchers wrote.
With medical care for patients with chronic diseases representing 75% of U.S. healthcare costs and hospitalizations representing one-third of all U.S. healthcare expenditures, better management of chronic medical conditions such as diabetes represents one clinical area in which improved care theoretically could reduce spending, the authors wrote. There is, however, limited and mixed evidence on the effect of EHRs on health outcomes or clinical events.
Methodology and results
With staggered EHR implementation across outpatient clinics in an integrated delivery system between 2005 and 2008, Kaiser Permanente Northern California created an opportunity for studying changes associated with EHR use. Mary Reed, DrPH, of Kaiser Permanente Northern California in Oakland, and colleagues examined the association between EHR implementation and ED visits, hospitalizations and office visits among patients with diabetes between 2004 and 2009. The patients were seen at 45 facilities in 17 medical centers. The study included all 169,711 patients in the health plans clinical diabetes registry at the beginning of the study period.
The researchers found that after use of the EHR, there were reductions in ED visits (28.8 fewer visits per 1,000 patients annually), overall hospitalizations (13.1 fewer visits) and nonelective hospitalizations (10.92 fewer visits). Hospitalizations specifically for ambulatory care-sensitive conditions also declined with EHR use (7.08 fewer visits).
However, there was no statistically significant difference in office visit rates with the implementation of an EHR. The decline in usage in other settings may reflect greater efficiency during visits or care delivery between visits, the authors wrote.
Further studies are needed to quantify the association of EHR with changes in costs, the authors wrote.
Study abstract: http://jama.jamanetwork.com/article.aspx?articleid=1737043