title: The effectiveness of implementing an electronic health record on diabetes care and outcomes.
abstract: OBJECTIVE
  To assess the impact of electronic health record (EHR) implementation on primary care diabetes care.
  
  
  METHODS
  Charts were abstracted semi-annually for 14,051 diabetes patients seen in 34 primary care practices in a large, fee-for-service network from January 1, 2005 to December 31, 2010. The study sample was limited to patients aged 40 years or older.
  
  
  METHODS
  A naturalistic experiment in which GE Centricity Physician Office-EMR 2005 was rolled out over a staggered 3-year schedule.
  
  
  METHODS
  Chart audits were conducted using the AMA/Physician Consortium Adult Diabetes Measure set. The primary outcome was the HealthPartners' "optimal care" measure: HbA1c ≤ 8 percent; LDL cholesterol < 100 mg/dl; blood pressure < 130/80 mmHg; not smoking; and documented aspirin use in patients ≥ 40 years of age.
  
  
  RESULTS
  After adjusting for patient age, sex, and insulin use, patients exposed to the EHR were significantly more likely to receive "optimal care" when compared with unexposed patients (p < .001), with an estimated difference of 9.20 percent (95% CI: 6.08, 12.33) in the final year between exposed patients and patients never exposed. Components of the optimal care bundle showing positive improvement after adjustment were systolic blood pressure <80 mmHg, diastolic blood pressure <130 mmHg, aspirin prescription, and smoking cessation. Among patients exposed to EHR, all process and outcome measures except HbA1c and lipid control showed significant improvement.
  
  
  CONCLUSIONS
  Implementation of a commercially available EHR in primary care practice may improve diabetes care and clinical outcomes.
authors.affiliation: Department of Medicine, Yale University, New Haven, CT, USA.
authors.forename: Jeph
authors.initials: J
authors.lastname: Herrin
authors.forename: Briget
authors.initials: B
authors.lastname: da Graca
authors.forename: David
authors.initials: D
authors.lastname: Nicewander
authors.forename: Cliff
authors.initials: C
authors.lastname: Fullerton
authors.forename: Phil
authors.initials: P
authors.lastname: Aponte
authors.forename: Greg
authors.initials: G
authors.lastname: Stanek
authors.forename: Terianne
authors.initials: T
authors.lastname: Cowling
authors.forename: Ashley
authors.initials: A
authors.lastname: Collinsworth
authors.forename: Neil S
authors.initials: NS
authors.lastname: Fleming
authors.forename: David J
authors.initials: DJ
authors.lastname: Ballard
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D000553:Ambulatory Care / Q000592:standards*; D016009:Chi-Square Distribution; D003920:Diabetes Mellitus / Q000628:therapy*; D057286:Electronic Health Records; D005260:Female; D006302:Health Services Research; D006801:Humans; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D015995:Prevalence; D011320:Primary Health Care / Q000592:standards*; D011787:Quality of Health Care; D012189:Retrospective Studies; D013781:Texas