title: The adoption of an electronic health record did not improve A1c values in Type 2 diabetes.
abstract: A major justification for the clinical adoption of electronic health records (EHRs) was the expectation that it would improve the quality of medical care. No longitudinal study has tested this assumption.
  
  
  
  We used hemoglobin A1c, a recognized clinical quality measure directly related to diabetes outcomes, to assess the effect of EHR use on clinical quality.
  
  
  
  We performed a five-and-one-half-year multicentre longitudinal retrospective study of the A1c values of 537 type 2 diabetic patients. The same patients had to have been seen on at least three occasions: once approximately six months prior to EHR adoption (before-EHR), once approximately six monthsafter EHR adoption (after-EHR) and once approximately five years after EHR adoption (five-years), for a total of 1,611 notes.
  
  
  
  The overall mean confidence interval (CI) A1c values for the before- EHR, after-EHR and five-years were 7.07 (6.91 - 7.23), 7.33 (7.14 - 7.52) and 7.19 (7.06 - 7.32), respectively. There was a small but significant increase in A1c values between before-EHR and after-EHR, p = .04; there were no other significant differences. There was a significant decrease in notes missing at least one A1c value, from 42% before-EHR to 16% five-years (p < .001).
  
  
  
  We found that based on patient's A1c values, EHRs did not improve the clinical quality of diabetic care in six months and five years after EHR adoption. To our knowledge, this is the first longitudinal study to directly assess the relationshipbetween the use of an EHR and clinical quality.
authors.affiliation: F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, USA. harry.burke@usuhs.edu.
authors.forename: Harry B
authors.initials: HB
authors.lastname: Burke
authors.affiliation: F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, USA. dorothy.becher.ctr@usuhs.edu.
authors.forename: Dorothy A
authors.initials: DA
authors.lastname: Becher
authors.affiliation: F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, USA. albertcaus@yahoo.com.
authors.forename: Albert
authors.initials: A
authors.lastname: Hoang
authors.affiliation: Department of Public Health Sciences, Clemson University, USA. rgimbel@clemson.edu.
authors.forename: Ronald W
authors.initials: RW
authors.lastname: Gimbel
mesh_terms: D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D004059:Diffusion of Innovation; D057286:Electronic Health Records; D006442:Glycated Hemoglobin / Q000032:analysis*; D006801:Humans; D008137:Longitudinal Studies; D012189:Retrospective Studies
chemical_list: D006442:Glycated Hemoglobin
keywords: diabetes; electronic health record; medical care; quality