EHRs Produce Better Clinical Outcomes In ClevelandEHRs Produce Better Clinical Outcomes In Cleveland

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In what could end up being a watershed moment for health IT, new research has shown a large difference in outcomes among diabetics whose providers have electronic health records (EHRs), as compared to patients whose doctors still use paper records.

Researchers from three major organizations in Cleveland, namely MetroHealth System, the Cleveland Clinic, and the Ohio Permanente Medical Group, an affiliate of Kaiser Permanente, found significantly greater adherence to standards of care and better outcomes for patients cared for with EHRs. They recently published their findings in the New England Journal of Medicine.

Most previous studies had failed to demonstrate the quality and efficiency improvements that EHRs are supposed to bring. "Projected cost savings are mostly based on models with largely unsupported assumptions about adherence to and the effect of fully functional EHR systems," the report said.

The Cleveland researchers examined data on more than 27,000 adults with diabetes at 46 practices in Northeastern Ohio and performed an analysis based on nine metrics, including four standards of care for diabetes patients and five measures of intermediate outcomes. They found that 50.9% of patients at sites with EHRs received care that met all four care standards, but only 6.6% of patients at paper-based practices did.

In terms of outcomes, 43.7% of practices with EHRs achieved at least four of the five standards, compared to 15.7% of those whose doctors did not have EHRs.

Three of seven participating organizations and 33 of the 46 practices had EHRs. Nearly 38% of patients were in safety-net practices. The practices are part of Better Health Greater Cleveland, a regional quality-improvement effort funded by the Robert Wood Johnson Foundation's Aligning Forces for Quality (AF4Q) program, one of 16 such collaborations nationwide.

Even after adjusting for factors that usually influence healthcare outcomes--e.g., race, income level, insurance status, whether care was delivered through a safety-net provider--EHR sites achieved the care standards at a rate 35.1 percentage points higher than did paper-based practices. The spread was 15.2 percentage points on outcomes, according to the study.

Results for safety-net practices were similar to those of the entire study pool.

"It wasn't a controlled trial, but the data were pretty compelling," lead researcher Dr. Randall D. Cebul, director of Case Western Reserve University's and MetroHealth Medical Center's Center for Health Care Research and Policy, told information Healthcare. He said that the results should give more momentum to the federal government's push to encourage EHR adoption through the "Meaningful Use" incentive program.

"These findings support the premise that federal policies encouraging the Meaningful Use of EHRs may improve the quality of care across insurance types," the study said.

As Cebul put it, "It's silly not to enter the electronic age." After seeing how EHRs can improve care, "Have nots will want to be haves," Cebul added.

Find out how health IT leaders are dealing with the industry's pain points, from allowing unfettered patient data access to sharing electronic records. Also in the new, all-digital issue of information Healthcare: There needs to be better e-communication between technologists and clinicians. Download the issue now. (Free registration required.)