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EHRs Beat Paper in Head-to-Head Competition

 |  By gshaw@healthleadersmedia.com  
   September 06, 2011

Electronic health records (EHRs) show promise to improve quality of care and patient outcomes—that’s why the federal government is investing billions of dollars in them. But data to quantify that potential has been inconclusive and sometimes controversial. Authors of a new study, published last week in the New England Journal of Medicine, say they are among the first to offer hard evidence that in a head-to-head competition, electronic records beat paper.

The researchers tracked quality measures and outcomes for more than 27,000 Cleveland-area adults with diabetes and found that those who were treated at physician practices using EHRs enjoyed substantially better outcomes than those who were treated by doctors relying on paper records.

The more than 500 primary care physicians in 46 practices who took part in the study are all members of Better Health Greater Cleveland, a nonprofit healthcare alliance made up of providers, health plans, employers, and government agencies focused on improving the health of chronic disease patients in Northeast Ohio.

Researchers looked at four national quality standards for care:

  1. timely measurements of blood sugar,
  2. management of kidney problems,
  3. eye examinations,
  4. vaccinations for pneumonia

Outcome measures included meeting national benchmarks for blood sugar, blood pressure, and cholesterol control, as well as more patient-driven actions such as achieving a non-obese Body Mass Index and avoiding tobacco use.

Among the findings:
  • Nearly 51% of patients in EHR practices received care that met all four of the endorsed standards, compared to just 7% of patients at paper-based practices.
  • Nearly 44% of patients in EHR practices met at least four of five outcome standards, compared to about 16% of patients at paper-based practices.
  • After accounting for patient differences, EHR practices had annual improvements in care that were 10% greater than paper-based practices, as well as 4% greater annual improvements in outcomes.

Furthermore, it made no difference whether patients were insured by commercial payers, Medicare, Medicaid, or even if they were uninsured—all showed better results in standards of care and outcomes.

“Some of the rather dramatic differences that we’re showing are a function of sharing across systems and best practices with regard to common conditions and common metrics that we’ve all agreed to attack,” Greater Health Director Randall Cebul, MD, the study’s lead author, told HealthLeaders Media.

“There’s a lot of coaching that goes on. We say we share ideas and compete on execution. Electronic Health Records are simply tools. And the master craftsman will have a workbench with all the tools on it but knows how to use them and uses them in the right circumstances,” said Cebul, who is also a medical professor at Case Western Reserve University and practices at The MetroHealth System—both organizations are members of Better Health Greater Cleveland. “We are training one another in what the tricks of the trade are, in order to do better on the kinds of things that in an increasingly busy primary care practice could be overlooked.”

The study should pave the way for similar projects, said David Kaelber, MD, MetroHealth’s chief medical informatics officer, in an interview. “I hope that this is one indication that we’re really getting to the tipping point.

For decades this has always been the hope—that eventually technology will transform healthcare as it has other industries. We’ve poured in billions and billions of dollars. But to date the real value seen from that investment has been minimal. This is one of the studies that really shows that the value of that investment is significant. So I think there will be many more examples of this in the future.”

Other healthcare systems can replicate the study results, Cebul says. But “to replicate this study in a faithful way would require that you do it in an environment within which practices agree they’re going to improve the care and outcomes of people with specified conditions and specified metrics.”

The results of this research are just the “tip of the iceberg” when it comes to proving the potential for EHRs, Kaelber said. “The reality is that even though it’s a great study, we’re only looking at diabetes and several outcomes. The future of this is that we should be seeing more and more studies like this and outcomes like this, where the electronic health records really are transforming the way that healthcare is delivered.”

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