Impact of an electronic medical record on diabetes quality of care.
OBJECTIVE
This study was designed to evaluate the impact of electronic medical record (EMR) implementation on quality of diabetes care.


METHODS
We conducted a 5-year longitudinal study of 122 adults with diabetes mellitus at an intervention (EMR) clinic and a comparison (non-EMR) clinic. Clinics had similarly trained primary care physicians, similar patient populations, and used a common diabetes care guideline that emphasized the importance of glucose control. The EMR provided basic decision support, including prompts and reminders for diabetes care. Preintervention and postintervention frequency of testing for glycated hemoglobin (HbA1c) and low-density lipoprotein (LDL) levels were compared with and without adjustment for patient age, sex, comorbidity, and baseline HbA1c level.


RESULTS
Frequency of HbA1c tests increased at the EMR clinic compared with the frequency at the non-EMR clinic (P < .001). HbA1c levels improved in both clinics (P < .05) with no significant differences between clinics 2 years (P = .10) or 4 years (P = .27) after EMR implementation. Similar results were observed for LDL levels.


CONCLUSIONS
In this controlled study, EMR use led to an increased number of HbA1c and LDL tests but not to better metabolic control. If EMRs are to fulfill their promise as care improvement tools, improved implementation strategies and more sophisticated clinical decision support may be needed.
O'Connor
Patrick J
PJ
HealthPartners Medical Group and HealthPartners Research Foundation, Minneapolis, MN 55440-1524, USA. patrick.j.oconnor@healthpartners.com
Crain
A Lauren
AL
Rush
William A
WA
Sperl-Hillen
Joann M
JM
Gutenkauf
Jay J
JJ
Duncan
Jane E
JE
D008078:Cholesterol, LDL / Q000097:blood; D003920:Diabetes Mellitus / Q000097:blood / Q000628:therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D016347:Medical Records Systems, Computerized; D008875:Middle Aged; D011320:Primary Health Care; D011787:Quality of Health Care
D008078:Cholesterol, LDL; D006442:Glycated Hemoglobin