Thursday, September 08, 2011

EHR Impact on Quality of Care - There Is Some Really Good News Here!

The New England Journal of Medicine published a really interesting paper last week.
Here is some of the press reporting.

Diabetics receive better care from docs with EHRs

September 1, 2011 — 1:30pm ET | By Dan Bowman
Although meeting Meaningful Use hasn't exactly been the easiest of feats for hospital CIOs, perhaps they can take solace in knowing that their patients will receive vastly superior care to those treated by doctors using paper records, according to the results of a new study published this week in the New England Journal of Medicine
Overall, 51 percent of participating patients treated at practices with electronic health records (EHR) received care that met four out of four care standards used in the study: timely blood sugar measurements, management of kidney problems, eye exams and pneumonia vaccinations. Only 7 percent of patients at practices using paper records received the same level of care.
In addition, care and outcome improvements on an annual basis were 10 and 4 percent greater, respectively, for practices using EHRs when compared to their paper-based counterparts. 
Lead author Randall Cebul, a professor of medicine at Case Western Reserve University, said he and his team weren't surprised by the study's outcome and acknowledged that EHRs aren't "an end-all-be-all" healthcare solution in a post on Health IT Buzz
More here:
Also here

Study finds higher clinical quality compliance at practices using EHRs

Posted: August 31, 2011 - 5:45 pm ET
Researchers from Case Western Reserve University, Cleveland, report that provider practices using electronic health-record systems had higher rates of compliance with clinical quality improvement measures for diabetic patients than did their clinical counterparts using paper-based record systems.
The research work was conducted in the Cleveland area, one of 16 communities the Robert Wood Johnson Foundation selected to receive funding for the foundation's Aligning Forces for Quality program. Through the program, office-based physician practices report on quality-of-care and outcomes measures for patients who have chronic medical conditions. Some of the participating Cleveland practices use paper-based recordkeeping systems; other use EHRs. All were members of the Better Health Greater Cleveland, a RWJR-funded collaborative for practice improvement.
The researchers' report, "Electronic Health Records and Quality of Diabetes Care," was published today in the New England Journal of Medicine.
Data measuring the care for diabetics has been reported six times under the auspices of the Better Health Greater Cleveland program and has come from practices with a high concentration of primary-care physicians.
The data reflect a review of nine quality standards—four process measures and five outcomes standards—for the care of diabetics.
The researchers looked at data from 569 primary-care providers, representing 46 practices and seven healthcare organizations, for 27,207 adult patients with diabetes from July 2009 through June 2010. A sample of group practices was split between 33 EHR-enabled provider groups and 13 paper-based practices.
More here:
Lastly there is some detailed coverage here:

EHR Incentives Likely to Improve Quality

September 01, 2011 | Brian Ahier
Healthcare is one of the last industries in the United States to universally incorporate technological advancements. While most sectors have made significant investments in information technology to improve efficiency and consumer relationships, America’s health care system is still largely paper-driven. As a result the healthcare system is plagued by inefficiency and poor quality. Delivery is slower, more prone to errors, and harder to measure and coordinate than it should be. Investments in health information technology can help improve this situation. Research published in the New England Journal of Medicine (FREE FULL TEXT) gives cause for optimism that efforts to increase adoption of electronic health records (EHRs) will provide major benefits in better patient care and health outcomes. Perhaps we can finally move away from using a dead tree medical recod system in this country.
“We were not surprised by these results,” said Randall D. Cebul, M.D., a professor of medicine at Case Western Reserve University and the study’s lead author who I was able to speak with earlier today. “They were influenced by several factors, including our public reporting on agreed-upon standards of care and the willingness of our clinical partners to share their EHR-based best practices while simultaneously competing on their execution.”
The research involved more than 500 primary care physicians in 46 practices that are partners in a region-wide collaborative known as Better Health Greater Cleveland (Better Health). This alliance of providers, businesses and other stakeholders is dedicated to enhancing the value of care for patients with chronic medical conditions in the region. Launched in 2007, the organization is one of 16 that the Robert Wood Johnson Foundation chose to support in its nationwide initiative, called Aligning Forces for Quality. This initiative is the foundation’s signature effort to lift the overall quality of health care in targeted communities as well as reduce racial and ethnic disparities and provide models that will help propel national reform. Common themes across the communities include public reporting of performance and community-wide initiatives to improve care.
As important as electronic health records are, Dr. Cebul said, their greatest value merges when used in conjunction with other approaches, such as the sharing of best practices and coaching offered through collaborations such as Better Health Greater Cleveland. "We've been doing summits twice yearly and will continue in the future so that we can identify and share best practices among providers. We also will provide ongoing coaching to practices that wish to continue to improve clinical outcomes," he said. The patient centered medical home is built on the foundation of electronic health records, and Better Health is working with employers and payers in the region to develop medical homes as well as exploring opportunities to participate in new payment models.
I asked Dr. Cebul what impact health information exchange will have on continuing improvements, particularly in the area of clinical care coordination. "I think that HIE will have a big benefit and it's value will be as much in cost reductions as it will in improving quality of care. For the smaller practices it will be very valuable in providing data from outside providers and specialists. HIE will enable us to reduce unnecessary emergency room visits and hospital readmission, as well as reducing duplicate testing. This will also accelerate the process of clinical evaluation and save money."
Vastly more here:
Here is the introduction to the paper.

Electronic Health Records and Quality of Diabetes Care

NEJM | August 31, 2011 | Topics: Health IT, Quality of Care
Randall D. Cebul, M.D., Thomas E. Love, Ph.D., Anil K. Jain, M.D., and Christopher J. Hebert, M.D.
Incentives to increase adoption and meaningful use of electronic health records (EHRs) anticipate a quality-related financial return.1,2 However, empirical data showing either quality improvement or cost savings from EHR adoption are scarce. Available studies have shown few quality-related advantages of current EHR systems over traditional paper-based medical-record systems.1-5 Projected cost savings are mostly based on models with largely unsupported assumptions about adherence to and the effect of fully functional EHR systems.6,7 Data are particularly scarce on EHR adoption by “priority primary care providers” — health care professionals practicing in small groups and those serving vulnerable populations, as such providers are defined in the Health Information Technology for Economic and Clinical Health (HITECH) Act.8 EHR adoption by such providers is supported by the national network of Health Information Technology Regional Extension Centers.
Innovations in care delivery as specified in the Affordable Care Act, such as accountable care organizations and patient-centered medical homes (PCMHs), also provide incentives for using information most easily obtained through EHR systems.9,10 Data regarding the benefits of PCMHs have come largely from reports by EHR-based organizations,11-13 and these data support the posited links among EHR use, quality improvement, and cost savings. However, these reports did not compare EHR and paper-based systems.
The full paper is found here (free to access)
This is a really important paper in my view showing how the use of electronic records - in the hands of a care provider - can really improve the quality of care.
It would be good if we had some evidence regarding the value of the proposed PCEHR - but it seems the Government and NEHTA simply don’t have a clue about what does work and what may work and focus its efforts on what does work.
Just plain dumb.

1 comment:

InformaticsMD said...

Alas, consider these observations:

Yet more health IT articles based on functionalist and determinist assumptions of the general format "what is the impact of technology X on outcome Y"