title: Electronic health records in four community physician practices: impact on quality and cost of care.
abstract: OBJECTIVE
  To assess the impact of the electronic health record (EHR) on cost (i.e., payments to providers) and process measures of quality of care.
  
  
  METHODS
  Retrospective before-after-study-control. From the database of a large managed care organization (MCO), we obtained the claims of patients from four community physician practices that implemented the EHR and from about 50 comparison practices without the EHR in the same counties. The diverse patient and practice populations were chosen to be a sample more representative of typical private practices than has previously been studied.
  
  
  METHODS
  For four chronic conditions, we used commercially-available software to analyze cost per episode over a year and the rate of adherence to clinical guidelines as a measure of quality.
  
  
  RESULTS
  The implementation of the EHR had a modest positive impact on the quality measure of guideline adherence for hypertension and hyperlipidemia, but no significant impact for diabetes and coronary artery disease. No measurable impact on the short-term cost per episode was found. Discussions with the study practices revealed that the timing and comprehensiveness of EHR implementation varied across practices, creating an intervention variable that was heterogeneous.
  
  
  CONCLUSIONS
  Guideline adherence increased across practices without EHRs and slightly faster in practices with EHRs. Measuring the impact of EHRs on cost per episode was challenging, because of the difficulty of completely capturing the long-term episodic costs of a chronic condition. Few practices associated with the study MCO had implemented EHRs in any form, much less utilizing standardized protocols.
authors.affiliation: UnitedHealthcare, Edina, MN 55346, USA.
authors.forename: W Pete
authors.initials: WP
authors.lastname: Welch
authors.forename: Dawn
authors.initials: D
authors.lastname: Bazarko
authors.forename: Kimberly
authors.initials: K
authors.lastname: Ritten
authors.forename: Yo
authors.initials: Y
authors.lastname: Burgess
authors.forename: Robert
authors.initials: R
authors.lastname: Harmon
authors.forename: Lewis G
authors.initials: LG
authors.lastname: Sandy
mesh_terms: D003153:Community Health Services / Q000191:economics / Q000458:organization & administration* / Q000592:standards; D003327:Coronary Disease / Q000628:therapy; D003920:Diabetes Mellitus / Q000628:therapy; D019983:Guideline Adherence; D017048:Health Care Costs; D006801:Humans; D006949:Hyperlipidemias / Q000628:therapy; D006973:Hypertension / Q000628:therapy; D008329:Managed Care Programs / Q000458:organization & administration; D016347:Medical Records Systems, Computerized / Q000191:economics*; D017410:Practice Guidelines as Topic; D011787:Quality of Health Care; D012189:Retrospective Studies; D012984:Software