Electronic health records, clinical decision support, and blood pressure control.
ABSTRACT Adding clinical decision support (CDS) to electronic health records (EHRs) is required under meaningful use legislation, but there has been little national data on effectiveness in improving clinical outcomes. We sought to determine whether EHRs with CDS improved blood pressure control in US primary care visits. Study Design: We used a cross-sectional, nationally representative survey.
We examined adult visits to primary care physicians using the 2007 and 2008 National Ambulatory Medical Care Survey (NAMCS).
We found that patients had a mean age of 52 years, 34% were male, 15% had diabetes, and 70% were white. Rates of blood pressure control were significantly higher in visits where both an EHR and CDS (79%) were used, compared with visits where physicians used neither tool (74%; P = .004). Blood pressure control rates remained higher after adjusting for potential confounders. In unadjusted analyses, mean systolic blood pressure was 2 mm Hg lower in visits with the use of both an EHR and CDS, compared with visits where physicians used neither tool (P = .03), and this difference remained significant after adjustment.
The NAMCS shows that physician use of an EHR with CDS is associated with improved blood pressure control. These findings are important because small improvements in blood pressure control are associated with reductions in cardiovascular morbidity and mortality.
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ABSTRACT: Health information technology (HIT) can increase preventive care. There are hopes and fears about the impact of HIT on racial disparities in cancer screening. To determine whether electronic health records (EHRs) or electronic preventive care reminders (e-reminders) modify racial differences in cancer screening order rates. Using the 2006-2010 National Ambulatory and National Hospital Ambulatory Medical Care Surveys, we measured (1) visit-based differences in rates of age-appropriate breast, cervical and colon cancer screening orders between white and non-white subjects at primary care visits with and without EHRs, and, at visits with EHRs, with and without e-reminders, and (2) whether EHRs or e-reminders modified these differences. Mammography (N=45 380); Pap smears (N=73 348); and sigmoidoscopy/colonoscopy (N=50 955) orders. Among an estimated 2.4 billion US adult primary care visits, orders for screening for breast, cervical or colon cancer did not differ between clinics with and without EHRs or e-reminders. There was no difference in screening orders between non-white and white patients for breast (aOR=1.1; 95% CI 0.9 to 1.4) or cervical cancer (aOR=1.2; 95% CI 1.0 to 1.3). For colon cancer, non-white patients were more likely to receive screening orders than white patients overall (aOR=1.5; 95% CI 1.1 to 2.0), at visits with EHRs (aOR=1.8; 95% CI 1.1 to 2.8) and at visits with e-reminders (aOR=2.1; 95% CI 1.2 to 3.7). EHRs or e-reminders did not modify racial differences in cancer screening rates. In this visit-based analysis, non-white patients had higher colon cancer screening order rates than white patients. Despite hopes and fears about HIT, EHRs and e-reminders did not ameliorate or exacerbate racial differences in cancer screening order rates.Journal of the American Medical Informatics Association 03/2014; 21(E2). DOI:10.1136/amiajnl-2013-002439 · 3.93 Impact Factor
- Current Cardiovascular Risk Reports 01/2014; 9(1). DOI:10.1007/s12170-014-0422-5
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ABSTRACT: The effect of electronic medical records (EMRs) on quality of care in physicians' offices is uncertain. This study used the 2008-2009 National Ambulatory Medical Care Survey to examine the relationship between EMRs features and quality in physician offices. The relationship between selected EMRs features and 7 quality measures was evaluated by testing 25 associations in multivariate models. Significant relationships include reminders for guideline-based interventions or screening tests associated with lower odds of inappropriate urinalysis and prescription of antibiotics for upper respiratory infection (URI), prescription order entry associated with lower odds of prescription of antibiotics for URI, and patient problem list associated with higher odds of inappropriate prescribing for elderly patients. EMRs system level was associated with lower odds of blood pressure check, inappropriate urinalysis, and prescription of antibiotics for URI compared with no EMRs. The results show both positive and inverse relationships between EMRs features and quality of care.American Journal of Medical Quality 04/2013; 29(1). DOI:10.1177/1062860613483870 · 1.78 Impact Factor