The NewEngland Journal of Medicine published a really interesting paper last week.
Here is someof the press reporting.
Diabetics receive better care from docs with EHRs
September1, 2011 — 1:30pm ET | By Dan Bowman
Althoughmeeting Meaningful Use hasn't exactly been the easiest of feats for hospitalCIOs, perhaps they can take solace in knowing that their patients willreceive vastly superior care to those treated by doctors using paper records,according to the results of a newstudy published this week in the New England Journal of Medicine.
Overall,51 percent of participating patients treated at practices with electronichealth records (EHR) received care that met four out of four care standardsused in the study: timely blood sugar measurements, management of kidneyproblems, eye exams and pneumonia vaccinations. Only 7 percent of patients atpractices using paper records received the same level of care.
Inaddition, care and outcome improvements on an annual basis were 10 and 4percent greater, respectively, for practices using EHRs when compared to theirpaper-based counterparts.
Leadauthor Randall Cebul, a professor of medicine at Case Western ReserveUniversity, said he and his team weren't surprised by the study's outcome andacknowledged that EHRs aren't "an end-all-be-all" healthcare solutionin a poston HealthIT Buzz.
Morehere:
Also here
Study finds higher clinical quality compliance atpractices using EHRs
Posted:August 31, 2011 - 5:45 pm ET
Researchersfrom Case Western Reserve University, Cleveland, report that provider practicesusing electronic health-record systems had higher rates of compliance withclinical quality improvement measures for diabetic patients than did theirclinical counterparts using paper-based record systems.
The researchwork was conducted in the Cleveland area, one of 16 communities the Robert WoodJohnson Foundation selected to receive funding for the foundation's AligningForces for Quality program. Through the program, office-based physicianpractices report on quality-of-care and outcomes measures for patients who havechronic medical conditions. Some of the participating Cleveland practices usepaper-based recordkeeping systems; other use EHRs. All were members of theBetter Health Greater Cleveland, a RWJR-funded collaborative for practiceimprovement.
Theresearchers' report, "ElectronicHealth Records and Quality of Diabetes Care," was published today inthe New England Journal of Medicine.
Datameasuring the care for diabetics has been reported six times under the auspicesof the Better Health Greater Cleveland program and has come from practices witha high concentration of primary-care physicians.
The datareflect a review of nine quality standards—four process measures and fiveoutcomes standards—for the care of diabetics.
Theresearchers looked at data from 569 primary-care providers, representing 46practices and seven healthcare organizations, for 27,207 adult patients withdiabetes from July 2009 through June 2010. A sample of group practices wassplit between 33 EHR-enabled provider groups and 13 paper-based practices.
More here:
Lastly thereis some detailed coverage here:
EHR Incentives Likely to Improve Quality
September01, 2011 | Brian Ahier
Healthcareis one of the last industries in the United States to universally incorporatetechnological advancements. While most sectors have made significantinvestments in information technology to improve efficiency and consumerrelationships, America’s health care system is still largely paper-driven. As aresult the healthcare system is plagued by inefficiency and poor quality.Delivery is slower, more prone to errors, and harder to measure and coordinatethan it should be. Investments in health information technology can helpimprove this situation. Research published in the NewEngland Journal of Medicine (FREE FULL TEXT)gives cause for optimism that efforts to increase adoption of electronic healthrecords (EHRs) will provide major benefits in better patient care and healthoutcomes. Perhaps we can finally move away from using a dead tree medical recodsystem in this country.
“Wewere not surprised by these results,” said Randall D. Cebul, M.D., a professorof medicine at Case WesternReserve University and the study’s lead author who I was able to speak with earliertoday. “They were influenced by several factors, including our public reportingon agreed-upon standards of care and the willingness of our clinical partnersto share their EHR-based best practices while simultaneously competing on theirexecution.”
Theresearch involved more than 500 primary care physicians in 46 practices thatare partners in a region-wide collaborative known as BetterHealth Greater Cleveland (Better Health). This alliance ofproviders, businesses and other stakeholders is dedicated to enhancing thevalue 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 tosupport in its nationwide initiative, called Aligning Forces for Quality.This initiative is the foundation’s signature effort to lift the overallquality of health care in targeted communities as well as reduce racial andethnic disparities and provide models that will help propel national reform.Common themes across the communities include public reporting of performanceand community-wide initiatives to improve care.
Asimportant as electronic health records are, Dr. Cebul said, their greatestvalue merges when used in conjunction with other approaches, such as thesharing of best practices and coaching offered through collaborations such asBetter Health Greater Cleveland. "We've been doing summits twice yearlyand will continue in the future so that we can identify and share bestpractices among providers. We also will provide ongoing coaching to practicesthat wish to continue to improve clinical outcomes," he said. The patientcentered medical home is built on the foundation of electronic health records,and Better Health is working with employers and payers in the region to developmedical homes as well as exploring opportunities to participate in new paymentmodels.
Iasked Dr. Cebul what impact health information exchange will have on continuingimprovements, particularly in the area of clinical care coordination. "Ithink that HIE will have a big benefit and it's value will be as much in costreductions as it will in improving quality of care. For the smaller practicesit will be very valuable in providing data from outside providers andspecialists. HIE will enable us to reduce unnecessary emergency room visits andhospital readmission, as well as reducing duplicate testing. This will alsoaccelerate the process of clinical evaluation and save money."
Vastlymore here:
Here is theintroduction to the paper.
Electronic Health Records and Quality ofDiabetes Care
NEJM |August 31, 2011 | Topics: Health IT, Quality of Care
RandallD. Cebul, M.D., Thomas E. Love, Ph.D., Anil K. Jain, M.D., and Christopher J.Hebert, M.D.
Incentivesto increase adoption and meaningful use of electronic health records (EHRs)anticipate a quality-related financial return.1,2 However, empiricaldata showing either quality improvement or cost savings from EHR adoption arescarce. Available studies have shown few quality-related advantages of currentEHR systems over traditional paper-based medical-record systems.1-5Projected cost savings are mostly based on models with largely unsupportedassumptions about adherence to and the effect of fully functional EHR systems.6,7Data are particularly scarce on EHR adoption by “priority primary careproviders” — health care professionals practicing in small groups and thoseserving vulnerable populations, as such providers are defined in the HealthInformation Technology for Economic and Clinical Health (HITECH) Act.8EHR adoption by such providers is supported by the national network of HealthInformation Technology Regional Extension Centers.
Innovationsin care delivery as specified in the Affordable Care Act, such as accountablecare organizations and patient-centered medical homes (PCMHs), also provideincentives for using information most easily obtained through EHR systems.9,10Data regarding the benefits of PCMHs have come largely from reports byEHR-based organizations,11-13 and these data support the positedlinks among EHR use, quality improvement, and cost savings. However, thesereports did not compare EHR and paper-based systems.
Thefull paper is found here (free to access)
Thisis a really important paper in my view showing how the use of electronicrecords - in the hands of a care provider - can really improve the quality ofcare.
Itwould 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 whatdoes work and what may work and focus its efforts on what does work.
Justplain dumb.
David.
