EHRs lead to increased testing, positive outcomes in patients with diabetes, high cholesterol

EHR implementation at Kaiser Permanente Northern California (KPNC) facilities led to improved drug treatment intensification, monitoring and physiologic control among patients with diabetes and high cholesterol, according to research published Oct. 1 in the Annals of Internal Medicine. 

Researchers led by Mary E. Reed, DrPH, a staff scientist at the Kaiser Permanente Northern California Division of Research, included all 169,711 Kaiser Permanente Northern California patients over age one with records in the integrated health system’s diabetes clinical registry at the end of 2003. To evaluate the effect of EHRs, which were implemented at the organization’s 17 facilities between 2005 and 2008, researchers used pre-implementation records of HbA1C and LDL-C values and tests as a baseline and compared them to post-implementation records. 

Pre-implementation, there was 27.5 percent chance that patients with HbA1C levels of more than 9 percent would return for a retest within 90 days and an 83.5 percent chance they would return within one year. Post-implementation, there was a 28.3 percent chance they would return within 90 days and an 86.7 percent chance they would return within one year. 

Pre-implementation, there was a 26 percent chance patients with LDL-C levels greater than 3.4 mmol/L would return for a retest within 90 days and an 86.2 percent chance they would return within one year. Post-implementation, there was a 27 percent chance they would return within 90 days and an 89.7 percent chance they would return within one year. 

EHRs were associated with a 0.14 percent reduction in HbA1C levels in patients with a baseline value higher than 9 percent and a decrease of .06 mmol/L in patients with a baseline LDL-C value greater than 3.4 mmol/L.

While a trend toward improvement in diabetes care was already apparent through Kaiser Permanente Northern California prior to the study, researchers still determined that EHRs produced favorable effects. 

“The EHR helped alignment with quality measures and clinical guidelines for treatment,” Reed et al wrote. “Increases in information availability, decision support and order entry functionality helped clinicians to better target retesting.” 

“Our study suggests that the EHR may be a powerful tool to help clinicians deliver well-targeted, high-quality chronic disease care and improve patient outcomes,” they concluded.