title: Record media used by primary care providers in medically underserved regions of upstate New York was not pivotal to clinical result in the Informatics for Diabetes Education and Telemedicine (IDEATel) project.
abstract: OBJECTIVE
  To examine integration of electronic medical records (EMRs) by primary care providers (PCPs) in a diabetes telemedicine project (IDEATel) in medically underserved rural areas and assess if access to digital records is associated with diabetes intermediate outcomes.
  
  
  METHODS
  PCPs (n=61) with patients in IDEATel participated in structured interviews to determine current (2006 to 2007) and projected (2007 to 2008) use of paper and/or electronic medical data. T-tests examined group differences.
  
  
  RESULTS
  28% (17/61) of PCPs had comprehensive EMRs, but most electronic data were non-interoperative between offices; 6% of PCPs solely used paper; 92% of PCPs used mixed paper/electronic records. Half of 61 PCPs anticipated no migration within one year to an electronic record for common patient data, while one third anticipated that function would become greatly more electronic. Among 31 PCPs interviewed in depth in person, 70% (7/10) in private practice and 69% (9/13) in networks anticipated greater electronic media migration through system change, whereas 100% of responding academic PCPs (n=6) expected only system modifications. PCPs were most interested in data exchange for chronic disease management (94%), regional benchmarking (84%) and quality improvement (87%). Patient personal electronic health records were rarely mentioned. IDEATel patients of PCPs with or without access to comprehensive EMRs achieved similar haemoglobin A1c, blood pressure, LDL-cholesterol, and body mass index, but the small number invokes cautious interpretation.
  
  
  CONCLUSIONS
  Our findings suggest an effective and complementary element of national health information technology (HIT) strategy, telemedicine, can be implemented by PCPs with success despite the lack of a concurrent EMR for efficient data exchange.
authors.affiliation: Department of Medicine, SUNY Upstate Medical University, Syracuse, NY 13210, USA.
authors.forename: Philip C
authors.initials: PC
authors.lastname: Morin
authors.forename: L Thomas
authors.initials: LT
authors.lastname: Wolff
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Eimicke
authors.forename: Jeanne A
authors.initials: JA
authors.lastname: Teresi
authors.forename: Steven
authors.initials: S
authors.lastname: Shea
authors.forename: Ruth S
authors.initials: RS
authors.lastname: Weinstock
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D003920:Diabetes Mellitus / Q000628:therapy*; D005260:Female; D055991:Health Records, Personal; D006801:Humans; D008297:Male; D008498:Medical Record Linkage / Q000379:methods; D008507:Medically Underserved Area; D008875:Middle Aged; D009518:New York; D010353:Patient Education as Topic / Q000379:methods*; D011320:Primary Health Care / Q000379:methods*; D017216:Telemedicine