Electronic Health Record Reduces ER Visits, Hospitalizations

Improvement in quality of care seen

Use of an outpatient electronic health record (EHR) at Kaiser Permanente Northern California was associated with significant decreases in emergency department visits and hospitalizations among patients with diabetes, as reported in JAMA. No change in office visit rates was found.

“Using the electronic health record in the outpatient setting improved the quality of care in ways that cumulatively resulted in fewer negative events,” said lead author Mary Reed, DrPH, staff scientist with the Kaiser Permanente Division of Research in Oakland, Calif. “A reduction in the number of emergency department visits represents not just improvements in diabetes care, but the cumulative effect of the EHR across many different care pathways and conditions.”

“Modest” Reductions in ER Visits Found

Dr. Reed and colleagues examined records from 169,711 patients with diabetes before and after EHR implementation at 45 facilities in 17 medical centers in northern California. The study was funded by the National Institute of Diabetes and Digestive and Kidney Diseases and the Agency for Healthcare Research and Quality.

They found that patients visited the emergency room 29 fewer times per 1,000 patients (from 519 to 490 visits) and were hospitalized 13 fewer times per 1,000 patients (from 252 to 239 visits) annually after EHR implementation (P<0.05 for both comparisons).

The authors called these changes “modest” and noted that “further studies are needed to quantify the association of EHR use with changes in costs.” Implementation of this EHR system was funded by the National Institute of Diabetes and Digestive and Kidney Diseases and the Agency for Healthcare Research and Quality. However, in a previous study involving EHR use in the same population, the authors noted that “even with federal incentive payments to offset the costs, implementing a complete EHR system requires a large up-front investment of money and time, with careful coordination across stakeholders and end users.”

Potential Benefits of EHR on Diabetes Management

In their previous study, the authors noted that EHR implementation was associated with improvements in medication treatment intensification after elevated glycosylated hemoglobin or low-density lipoprotein levels, rates of follow-up laboratory testing, and reductions in glycosylated hemoglobin and low-density lipoprotein levels. Patients with poorer disease control experienced greater benefit from EHR use in this study.

“In the 21st century Americans view computers in the workplace connected to the internet as standard for doing business. In healthcare, that has not been the case,” commented Kevin Larsen, MD, FACP, Medical Director of Meaningful Use in the Office of the National Coordinator for Health Information Technology, U.S. Department of Health and Human Services. “In the last few years hospitals, providers and the federal government have made substantial investments in implementation of EHRs with the promise of improve care and improving efficiency,” he explained.

“The article by Reed et al shows how an EHR at Kaiser is improving efficiency,” Dr. Larsen said. “In another recent article, Kaiser demonstrated how they improved quality by controlling the blood pressure of 300,000 people using an EHR. Together these articles demonstrate the promise of health information technology,” he said.

“Coordination is likely one of the key ways that Kaiser decreased emergency department and hospital use. The Meaningful Use program is designed to achieve outcomes like these,” Dr. Larsen added. Furthermore, he noted “EHRs help patients because their doctors and nurses have much better access to information that is important for decision making, like medications, allergies and test results. EHRs are also terrific at helping providers communicate with each other about the details of care.”

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