Electronic health records linked to improved care for patients with diabetes

OAKLAND, Calif., September 10, 2013 — The use of electronic health records in clinical settings was associated with a decrease in emergency room visits and hospitalizations for patients with diabetes, according to a study published today in the Journal of the American Medical Association.

Researchers examined the medical records of 169,711 diabetic patients over 1 year of age in the Kaiser Permanente diabetes clinical registry before and after the implementation of Kaiser Permanente HealthConnect®, the organization's comprehensive EHR system. They found that patients visited the emergency room 29 fewer times per 1,000 patients and were hospitalized 13 fewer times per 1,000 patients annually after the implementation.

"Using the electronic health record in the outpatient setting improved the quality of care in ways that cumulatively resulted in fewer negative events," said Mary Reed, DrPH, staff scientist with the Kaiser Permanente Division of Research in Oakland, Calif., and the study's lead author. "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."

Researchers found that annual emergency room visits declined 5.5 percent, from 519 visits per 1,000 diabetes patients before electronic health records to 490 visits per 1,000 diabetes patients afterward. Annual hospitalizations declined 5.2 percent, from 239 per 1,000 diabetes patients before electronic health records to 252 per 1,000 diabetes patients afterward. The researchers did not find any significant change in the number of office visits for patients with diabetes before and after electronic health records were implemented.

"This study demonstrates that when doctors and patients use an EHR, good things happen," said Marc G. Jaffe, MD, a study co-author and Kaiser Permanente endocrinologist in South San Francisco. "The current study adds to our understanding by describing how an EHR like KP HealthConnect can help doctors keep patients healthy when used as part of an integrated care delivery system."

Kaiser Permanente is widely recognized for its leadership in harnessing health IT to improve quality and care delivery. Kaiser Permanente HealthConnect®, the health care organization's electronic health record, is one of the most robust and sophisticated in the nation.

KP HealthConnect enables all Kaiser Permanente clinicians to electronically access their patients' Kaiser Permanente medical records and serves as a model for other care systems. The EHR is directly connected to My Health Manager on kp.org, which empowers members with easy and convenient access to their health information and health management tools like the ability to email their care teams or refill prescriptions.

KP HealthConnect gives providers an important tool to improve the quality of the care and service delivered to members and patients. It helps ensure patient safety and quality care by providing access to comprehensive patient information by supporting care team coordination and communication, and including the latest best-practice research in one place.

This study is part of Kaiser Permanente's ongoing work to better understand how EHRs affect clinical care. In October of last year, Kaiser Permanente researchers found that use of the electronic health records was associated with improved drug-treatment intensification, monitoring and risk-factor control among patients with diabetes.

In addition to Reed, co-authors of the study were Jie Huang, PhD, Ilana Graetz, PhD, Romain Neugebauer, PhD, Bruce Fireman, MA, of the Kaiser Permanente Division of Research; Richard Brand, PhD, of the Department of Epidemiology and Biostatistics, University of California, San Francisco; Marc Jaffe, MD, Department of Medicine and Endocrinology, The Permanente Medical Group, South San Francisco; Dustin W. Ballard, MD, MBE, Department of Emergency Medicine, The Permanente Medical Group, San Rafael, Calif.; and John Hsu, Massachusetts General Hospital, Harvard Medical School, Boston.

The study was funded by the National Institute of Diabetes and Digestive and Kidney Diseases and the Agency for Healthcare Research and Quality.

The Kaiser Permanente Division of Research conducts, publishes and disseminates epidemiologic and health services research to improve the health and medical care of Kaiser Permanente members and society at large. It seeks to understand the determinants of illness and well-being, and to improve the quality and cost-effectiveness of health care. Currently, DOR's 550-plus staff is working on more than 250 epidemiological and health services research projects. For more information, visit http://www.dor.kaiser.org.

Kaiser Permanente is committed to helping shape the future of health care. We are recognized as one of America's leading health care providers and not-for-profit health plans. Founded in 1945, our mission is to provide high-quality, affordable health care services and to improve the health of our members and the communities we serve. We currently serve more than 9.1 million members in nine states and the District of Columbia. Care for members and patients is focused on their total health and guided by their personal physicians, specialists and team of caregivers. Our expert and caring medical teams are empowered and supported by industry-leading technology advances and tools for health promotion, disease prevention, state-of-the-art care delivery and world-class chronic disease management. Kaiser Permanente is dedicated to care innovations, clinical research, health education and the support of community health. For more information, go to kp.org/newscenter.