Use of an electronic medical record improves the quality of urban pediatric primary care.
OBJECTIVE
To evaluate the quality of pediatric primary care, including preventive services, before and after the introduction of an electronic medical record (EMR) developed for use in an urban pediatric primary care center.


METHODS
A pre-postintervention analysis was used in the study. The intervention was a pediatric EMR. Routine health care maintenance visits for children <5 years old were reviewed, and documentation during preintervention (paper-based, 1998) and postintervention visits (computer-based, 2000) was compared.


RESULTS
A total of 235 paper-based visits and 986 computer-based visits met study criteria. Twelve clinicians (all attendings or nurse practitioners) contributed an average of 19.4 paper-based visits (range: 5-39) and 7 of these clinicians contributed an average of 141 computer-based visits each (range: 61-213). Computer-based clinicians were significantly more likely to address a variety of routine health care maintenance topics including: diet (relative risk [RR]: 1.09), sleep (RR: 1.46), at least 1 psychosocial issue (RR: 1.42), smoking in the home (RR: 15.68), lead risk assessment (RR: 106.54), exposure to domestic or community violence (RR: 35.19), guns in the home (RR: 58.11), behavioral or social developmental milestones (RR: 2.49), infant sleep position (RR: 9.29), breastfeeding (RR: 1.99), poison control (RR: 3.82), and child safety (RR: 1.29). Trends toward improved lead exposure, vision, and hearing screening were seen; however, differences were not significant. Users of the system reported that its use had improved the overall quality of care delivered, was well-accepted by families, and improved guidance quality; however, 5 of 7 users reported that eye-to-eye contact with patients was reduced, and 4 of 7 reported that use of the system increased the duration of visits (mean: 9.3 minutes longer). All users recommended continued use of the system.


CONCLUSIONS
Use of the EMR in this study was associated with improved quality of care. This experience suggests that EMRs can be successfully used in busy urban pediatric primary care centers and, as recommended by the Institute of Medicine, must play a central role in the redesign of the US health care system.
Adams
William G
WG
Division of General Pediatrics, Boston Medical Center, Boston University School of Medicine, Boston, MA 02118, USA. badams@bu.edu
Mann
Adriana M
AM
Bauchner
Howard
H
D001071:Appointments and Schedules; D001291:Attitude of Health Personnel; D002648:Child; D002662:Child Health Services / Q000592:standards / Q000706:statistics & numerical data; D002675:Child, Preschool; D006801:Humans; D007115:Immunization Schedule; D007223:Infant; D016347:Medical Records Systems, Computerized / Q000706:statistics & numerical data*; D010372:Pediatrics / Q000592:standards* / Q000706:statistics & numerical data; D011314:Preventive Health Services / Q000592:standards / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000592:standards* / Q000706:statistics & numerical data; D011785:Quality Assurance, Health Care; D011787:Quality of Health Care; D018570:Risk Assessment; D019037:Urban Health Services / Q000592:standards / Q000706:statistics & numerical data