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EHRs reduced ED visits for patients with diabetes
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The use of electronic health records was linked to modestly lower rates of ED visits and hospitalizations among patients with diabetes, according to researchers.
“Specifically, use of the electronic health records [EHR] was associated with statistically significantly fewer emergency department visits, hospitalizations, and hospitalizations for any condition, non-elective hospitalizations, and hospitalizations for ambulatory care-sensitive conditions,” John Hsu, MD, MBA, MSCE, from the department of health care policy at Harvard Medical School, and colleagues wrote.
John Hsu
Researchers analyzed the relationship between use of EHRs and clinical events, such as ED visits and hospitalizations and office visits, among patients with diabetes (n=169,711) from 2004 to 2009 across outpatient clinics in an integrated delivery system (Kaiser Permanente Northern California). The study data included 4,997,585 person-months before EHR implementation and 4,648,572 person-months after EHR implementation by the patient’s clinician.
EHR use significantly reduced the number of ED visits per year (28.8 fewer visits per 1,000 patients; 95% CI, 20.28-37.32) from a mean 519.12 visits per 1,000 patients without using the EHR to 490.32 per 1,000 patients using the EHR, according to data.
Additional data indicate that EHR use was linked to 13.1 less hospitalizations per 1,000 patients per year (95% CI, 7.37-18.82), decreasing from a mean 251.6 hospitalizations per 1,000 patients per year with no EHR to 238.5 hospitalizations per 1,000 patients per year when using the EHR.
Similarly, non-elective hospitalizations (10.92 less per 1,000 patients annually) and ambulatory care-sensitive conditions (7.08 fewer per 1,000 patients annually) were reduced by EHR use, researchers wrote.
However, they reported no significant relationship between EHR use and the rate of office visits.
“EHR adoption has broad-reaching potential to affect health care delivery across many conditions and clinical pathways,” researchers wrote.
Disclosure: The researchers report no relevant financial disclosures.
Perspective
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Carol Rasmussen, MSN, APRN, CDE, FAADE
This study was well done; it identifies the impact an EHR has on a specific population. Although the numbers were modest in the emergency room visits and hospitalizations, it did impact the importance of clinic care. With this decrease, are there more frequent primary care visits to prevent complications and adverse effects, or are the clinics using the EHR to better manage the health maintenance portion of care?
I was very interested in the primary care outcomes, which showed EHR had a larger impact on those patients who were significantly less controlled. This may be due to the “flags” that most electronic charts have set up.
But some questions remain. Was access to diabetes education considered in the outcomes? Did it affect adverse events requiring hospitalization? Finally, is this a part of the EHR that is identifiable?
With meaningful use being required, the EHR needs to be useful in tracking the care and outcomes; needs to be able to help providers to better manage their patient population.
This study needs to be repeated as the information will be important to providers in the clinic and hospitals, in order to lead better care across the health care system.
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