Outpatient Electronic Health Records and the Clinical Care and Outcomes of Patients With Diabetes Mellitus

Introduction

The US government has spent billions of dollars in effort to improve the healthcare by the use of electronic health record (EHR). This study examines the effects of implementing certified EHR on management of patients with diabetes mellitus.

Method

The study was conducted from 2004 to 2009, at 17 medical center of Kaiser Permanente where certified EHR was implemented The focus of the study was patients with diabetes mellitus and enrolled in integrated delivery system. A baseline for values and testing for hemoglobin A1C (HbA1C) and low-density lipoprotein cholesterol (LDL-C) was noted in 2003. Following this post EHR implementation values and testing for HbA1C and LDL-C as well as changes in these patients’ medication regimen and testing were recorded.

Results

HbA1C level <7% showed decrease whereas ≥ 9% showed increase in treatment intensification and retest within 90 days post EHR implementation. Similar results were seen with LDL-C levels, as level of <2.6 mmol/L and ≥ 3.6 mmol/L showed reduction and 2.6-3.3 mmol/L showed rise of treatment intensification and retesting.

Discussion

There was improvement in management of worse disease control and decrease in number of retest in patient with good disease control. The results showed that the treatment intensification and a rise or fall in retest post HbA1C and LDL-C values were in accordance to clinical guidelines for management of diabetes mellitus, post EHR implementation. This suggests thoughtful clinical decisions based on clinical guidelines, which were easily available to physicians at point of care via the EHR.

Conclusion

Implementation of certified EHR improves the management of patients with diabetes mellitus.

Comments

The new medical knowledge and clinical guidelines that can improve patient outcomes are areas that are growing exponentially. Availability of these at the point of care can help improve patient outcomes and management, as well as prevent harm from unnecessary tests and retests. The presence of an EHR has the ability to make this practice possible as evident in the above study.