Electronic health records and quality of care for heart failure.
BACKGROUND
Electronic health records (EHRs) are considered an important technology to improve the quality of health care, yet few data exist regarding their effect on delivery of evidence-based care in the outpatient setting.


METHODS
IMPROVE HF is a prospective cohort study of 15,381 patients with HF or post myocardial infarction and left ventricular ejection fraction < or =35% cared for in 167 US outpatient cardiology practices. Baseline patient characteristics and quality data were collected by chart abstraction. To quantify care, 7 HF quality measures were assessed; practices with and without EHR were compared.


RESULTS
Among practices, 52% had EHR systems (30% EHR-only; 22% both EHR and paper) and 48% paper-only systems. Conformity with indicated care for practices with EHR systems was modestly higher for 2 of 7 quality measures compared to those without. After controlling for patient and site characteristics, use of EHR was associated with improved delivery of 3 of 7 quality measures (angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, aldosterone antagonist, and HF education), similar care for 3 measures (beta-blocker, anticoagulation for atrial fibrillation, and cardiac resynchronization therapy), and worse for 1 measure (implantable cardioverter-defibrillator).


CONCLUSIONS
These data are among the first to assess the potential influence of EHR on conformity with HF guidelines in the outpatient setting and suggest that EHR systems as currently deployed are associated with only modest differences in some, but not other, quality measures provided to HF patients compared with use of paper-only systems.
Walsh
Mary Norine
MN
The Care Group, LLC, Indianapolis, IN 46260, USA. macwalsh@iquest.net
Yancy
Clyde W
CW
Albert
Nancy M
NM
Curtis
Anne B
AB
Stough
Wendy Gattis
WG
Gheorghiade
Mihai
M
Heywood
J Thomas
JT
McBride
Mark L
ML
Mehra
Mandeep R
MR
O'Connor
Christopher M
CM
Reynolds
Dwight
D
Fonarow
Gregg C
GC
D000368:Aged; D002309:Cardiology / Q000592:standards; D057286:Electronic Health Records; D019317:Evidence-Based Medicine; D005260:Female; D019983:Guideline Adherence; D006333:Heart Failure / Q000628:therapy*; D006801:Humans; D008297:Male; D010045:Outpatients; D011446:Prospective Studies; D011787:Quality of Health Care; D014481:United States