Electronic Health Records and Ambulatory Quality of Care

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 amb...

Full description

Saved in:
Bibliographic Details
Published in:Journal of general internal medicine : JGIM 2013-04, Vol.28 (4), p.496-503
Main Authors: Kern, Lisa M., Barrón, Yolanda, Dhopeshwarkar, Rina V., Edwards, Alison, Kaushal, Rainu
Format: Article
Language:English
Subjects:
Adult
Ambulatory Care - organization & administration
Ambulatory Care - standards
Biological and medical sciences
Community health care
Cross-Sectional Studies
Electronic Health Records
Female
General aspects
Humans
Internal Medicine
Male
Medical sciences
Medicine
Medicine & Public Health
Middle Aged
Miscellaneous
New York
Original Research
Primary care
Primary Health Care - organization & administration
Primary Health Care - standards
Public health. Hygiene
Public health. Hygiene-occupational medicine
Quality of care
Quality of Health Care
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary: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.
ISSN:0884-8734
1525-1497
DOI:10.1007/s11606-012-2237-8