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Electronic records tied to fewer hospitalizations

Electronic records tied to fewer hospitalizations

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NEW YORK (Reuters Health) – Switching from paper to electronic medical records at health clinics led to “modest reductions” in the number of people with diabetes that went to the emergency room or were hospitalized, in a new study.

Researchers looking at before-and-after rates found both ER visits and hospital admissions dropped by between five and six percent once the computerized records were put in place, but that there was no change in the frequency of office visits.

The U.S. government has committed about $30 billion to support the adoption of electronic health records, or EHRs, by doctors and healthcare systems across the country.

“For a long time we’ve recognized the potential for these systems to affect the way healthcare is delivered, and hoped they would improve the quality of care and make patients healthier,” Mary Reed, from the Kaiser Permanente Division of Research in Oakland, California, said.

However, there hasn’t been much evidence to show whether that’s the case, said Reed, who led the new study.

She and her colleagues tracked about 170,000 people with diabetes who were treated at clinics affiliated with the Kaiser Permanente Northern California health system. At staggered dates between 2005 and 2008, each of those clinics transitioned to using electronic medical records.

Taking into account changes in diabetes care over time and differences between patients, the researchers found rates of ER use dropped from 519 visits per 1,000 diabetes patients each year to 490 visits per 1,000 patients after electronic records were put in place.

Likewise, hospitalization rates fell from 252 per 1,000 patients to 239 per 1,000 after the transition.

“We were pleasantly surprised to see these reductions,” Reed told Reuters Health.

She said the benefits may stem from improvements in the treatment of various conditions, not just diabetes. For example, past research has shown EHRs allowed doctors to better help patients control their cholesterol.

However, both before and after records were computerized, patients in the study had about six office visits every year, on average. And there was no clear change in how often they had diabetes exacerbations or developed cardiovascular diseases, Reed and her colleagues wrote Tuesday in the Journal of the American Medical Association.

“We as a country of course are investing very significantly in EHRs,” Dr. Rainu Kaushal, director of the Center for Healthcare Informatics and Policy at Weill Cornell Medical College in New York, said.

“This piece provides some early evidence that that investment is judicious,” she told Reuters Health.

However, Kaushal, who wasn’t involved in the new research, said computerized records are likely just one part of a larger model – one that emphasizes coordination of care and payment reform, for example – that may affect outcomes.

“An EHR is a critical infrastructural tool to change the way in which healthcare is delivered, but it is one of a set of tools that needs to be employed,” she said. “It’s when you start getting those pieces together … that you really start finding some significant changes in utilization.”

In a research letter published in the same journal, researchers found using an electronic medical record that included automated growth monitoring helped doctors pick up on cases of possible growth disorders among kids.

There were 28 new diagnoses of growth disorders among about 32,000 Finnish children in the year after electronic monitoring was implemented, compared to an average of four annual diagnoses in the preceding years, Dr. Ulla Sankilampi from Kuopio University Hospital and colleagues reported.

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