A study conducted at HMO giant Kaiser Permanente involving nearly 170,000 patients with diabetes found that use of electronic health records helped significantly reduce A1c levels (average blood glucose over the previous three months) and LDL cholesterol in patients with the highest levels, indicating better monitoring and treatment. Those with lower A1c and LDL values experienced incremental improvements. Since their target levels were under control, they underwent less testing, suggesting electronic health records could actually reduce overtesting.
The study, which appears tomorrow in Annals of Internal Medicine, was conducted between 2004 and 2009 at 17 medical centers in Northern California. During that period, Kaiser Permanente was making the transition from a patchwork of health IT systems and paper charts to Epic Systems at a cost of $4 billion—the largest implementation of a commercial electronic health record. The National Institute of Diabetes and Digestive and Kidney Diseases funded the study.
Patients who were tracked had been Kaiser members since 2003. “We wanted to determine whether an EHR had a positive or negative impact on diabetes patients,” says Marc Jaffe, an endocrinologist at Kaiser, and an author of the study. “It [use of EHRs] helps us target patients.”
Jaffe and his colleagues, including lead author and research scientist Mary Reed, looked at blood tests taken at intervals recommended by the American Diabetes Association, and drug prescriptions. They excluded patients on insulin, because intake was more difficult to gauge, and the bulk of diabetes patients in the registry were on pills. Jaffe posits that the drop in A1c and LDL levels was not only due to a readjustment in dosage or a switch in medication, but also possibly to better compliance to existing medication in patients with the most elevated levels.
At the very least, electronic health records didn’t harm patients. “Skeptics who say the effort and energy that go into implementing an EHR detract from care have clearly been disproved,” says Jaffe. Hopefully, those kinds of promising results can be replicated elsewhere.
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