Electronic Health Records Improve the Quality of Care in Underserved Populations: A Literature Review

ArticleinJournal of Health Care for the Poor and Underserved 23(3 Suppl):136-53 · August 2012with17 Reads
DOI: 10.1353/hpu.2012.0134 · Source: PubMed
Organizations in underserved settings are implementing or upgrading electronic health records (EHRs) in hopes of improving quality and meeting Federal goals for meaningful use of EHRs. However, much of the research that has been conducted on health information technology does not study use in underserved settings, or does not include EHRs. We conducted a structured literature search of MEDLINE to find articles supporting the contention that EHRs improve quality in underserved settings. We found 17 articles published between 2003 and 2011. These articles were mostly in urban settings, and most study types were descriptive in nature. The articles provide evidence that EHRs can improve documentation, process measures, guideline-adherence, and (to a lesser extent) outcome measures. Providers and managers believed that EHRs would improve the quality and efficiency of care. The limited quantity and quality of evidence point to a need for ongoing research in this area.
    • "worsened by the lack of an appointment system (i.e. patients were allowed to make unscheduled visits). It was also possible that the doctors assessed the patients without documenting the clinical data in their medical records. Adoption of an electronic health records system could be used as a means to improve documentation under such circumstances. (14) However, even in one study that used an electronic database, lipid investigations were only documented in a third of the patients. (15) Other studies have advocated the use of incentive systems, albeit with modest improvements in the quality of care. (16) There are other strategies to facilitate the adoption of CPGs, such as practice fa"
    [Show abstract] [Hide abstract] ABSTRACT: INTRODUCTION The aim of this study was to determine the extent to which primary care doctors assessed patients newly diagnosed with hypertension for the risk factors of cardiovascular disease (CVD) during the patients’ first clinic visit for hypertension. The study also aimed to examine the trend of assessment for CVD risk factors over a 15-year period. METHODS This retrospective study was conducted between January and May 2012. Data was extracted from the paper-based medical records of patients with hypertension using a 1:4 systematic random sampling method. Data collected included CVD risk factors and a history of target organ damage (TOD), which were identified during the patient’s first visit to the primary care doctor for hypertension, as well as the results of the physical examinations and investigations performed during the same visit. RESULTS A total of 1,060 medical records were reviewed. We found that assessment of CVD risk factors during the first clinic visit for hypertension was poor (5.4%–40.8%). Assessments for a history of TOD were found in only 5.8%–11.8% of the records, and documented physical examinations and investigations for the assessment of TOD and secondary hypertension ranged from 0.1%–63.3%. Over time, there was a decreasing trend in the percentage of documented physical examinations performed, but an increasing trend in the percentage of investigations ordered. CONCLUSION There was poor assessment of the patients’ CVD risk factors, secondary causes of hypertension and TOD at their first clinic visit for hypertension. The trends observed in the assessment suggest an over-reliance on investigations over clinical examinations.
    Full-text · Article · Sep 2015
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  • [Show abstract] [Hide abstract] ABSTRACT: The Institute of Medicine highlighted the fact that the U.S. health care system does not provide consistent, high quality medical care to all people. The routine use of health information technology (HIT) that includes certain key functions may be critical in reducing such disparities. We used logistic regression analyses to examine differences when it comes to the routine use of key HIT functions that are linked to improvements in clinical care. Physicians predominantly serving Black patients were more likely than physicians predominantly serving White patients to routinely use HIT to generate reminders for clinicians and patients about preventive services. Similarly, physicians predominantly serving Hispanic patients were more likely than physicians predominantly serving White patients to routinely use HIT to access patients' preferred language. Importantly, although minority-serving institutions have lower adoption rates overall, differences exist in the routine use of key HIT functions that have the potential to reduce health disparities.
    Article · Feb 2014
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