The federal government is spending billions of dollars in physician incentives to encourage the meaningful use of electronic health records (EHRs). While the use of EHRs has potential to improve patient health outcomes, the existing evidence has been limited and mixed.
To examine the association between implementing a commercially-available outpatient EHR and emergency department (ED) visits, hospitalizations, and office visits for patients with diabetes.
Staggered EHR implementation across outpatient clinics in an integrated delivery system between 2005 and 2008 created an opportunity for studying changes associated with EHR use.
Seventeen medical centers in an integrated delivery system, Kaiser Permanente Northern California.
Among a population-based sample of 169,711 patients with diabetes between 2004–2009, we analyzed 5.0 million person-months before EHR implementation and 4.6 million person-months after an EHR was being used by patients’ physicians.
Meaningful use of a federally-certified complete outpatient EHR.
Main outcomes and measures
We examined the association between EHR use and unfavorable clinical events (ED visits and hospitalizations) and office visit use among patients with diabetes using multivariable regression with patient level fixed effect analyses and adjustment for trends over time.
In multivariable analyses, the EHR was associated with a statistically significantly lower number of ED visits, 28.80 fewer visits per 1,000 patients annually (95% CI: 20.28 to 37.32), from a mean of 519.12 visits per 1,000 patients annually without using the EHR to 490.32 per 1,000 patients when using the EHR. The EHR was also associated with 13.10 fewer hospitalizations per 1,000 patients annually (95% CI: 7.37 to 18.82), from a mean of 251.60 hospitalizations per 1,000 patients annually with no EHR, to 238.50 per 1,000 patients annually when using the EHR.
There were similar statistically significant reductions in non-elective hospitalizations (10.92 fewer per 1,000 patients annually) and hospitalizations for ambulatory care sensitive conditions (7.08 fewer per 1,000 patients annually). There was no statistically significant association between EHR use and office visit rates.
Conclusions and Relevance
Among patients with diabetes, use of an outpatient EHR in an integrated delivery system was associated with modest reductions in ED visits and hospitalizations but not office visit rates. Further studies are needed to quantify the association of EHR use with changes in costs.