Electronic records tied to fewer hospitalizations

By Genevra Pittman

NEW YORK (Reuters Health) - Switching to electronic health records (EHRs) at health clinics led to "modest reductions" in the number of diabetics who visited emergency rooms or were hospitalized, in a new study.

Researchers looking at before-and-after rates found both ER visits and hospital admissions dropped by about 6% once EHRs were in place. There was no change in the frequency of office visits, however.

"For a long time we've recognized the potential for these systems to affect the way healthcare is delivered, and hoped they would improve the quality of care and make patients healthier," said Mary Reed, from the Kaiser Permanente Division of Research in Oakland, California.

However, there hasn't been much evidence to show whether that's the case, said Reed, who led the new study.

She and her colleagues tracked about 170,000 diabetics who visited clinics affiliated with the Kaiser Permanente Northern California health system. At staggered dates between 2005 and 2008, each of those clinics transitioned to EHRs.

Taking into account changes in diabetes care over time and differences between patients, the researchers found rates of ER use dropped from 519 visits per 1,000 diabetes patients each year to 490 visits per 1,000 patients after EHRs were put in place.

Likewise, hospitalization rates fell from 252 per 1,000 patients to 239 per 1,000 after the transition.

"We were pleasantly surprised to see these reductions," Reed told Reuters Health.

She said the benefits may stem from improvements in the treatment of various conditions, not just diabetes. For example, past research has shown EHRs allowed doctors to better help patients control their cholesterol.

However, both before and after records were computerized, patients in the study had about six office visits every year, on average. And there was no clear change in how often they had diabetes exacerbations or developed cardiovascular diseases, Reed and her colleagues wrote September 10 in the Journal of the American Medical Association.

"We as a country of course are investing very significantly in EHRs," said Dr. Rainu Kaushal, director of the Center for Healthcare Informatics and Policy at Weill Cornell Medical College in New York. "This piece provides some early evidence that that investment is judicious."

Dr. Kaushal, who wasn't involved in the new research, said computerized records are likely just one part of a larger model - one that emphasizes coordination of care and payment reform, for example - that may affect outcomes.

In a letter published in the same journal, researchers found using an electronic medical record that included automated growth monitoring helped doctors pick up on cases of possible growth disorders among kids.

There were 28 new diagnoses of growth disorders among about 32,000 Finnish children in the year after electronic monitoring was implemented, compared to an average of four annual diagnoses in the preceding years, reported Dr. Ulla Sankilampi from Kuopio University Hospital and colleagues.

SOURCES: http://bit.ly/1aDlsD9 and http://bit.ly/16lCXDy

JAMA 2013.