Impact of Electronic Health Records (EHR) on Screening Colonoscopy Rates in Primary Care Clinics

Abstract

Ambulatory Care clinics are increasingly investing in Electronic Health Records (EHR) in an effort to improve the efficiency of primary care which includes primary prevention of diseases like colon cancer. The U.S. Preventive Services Task Force (USPSTF) recommends screening colonoscopy beginning at the age 50. While use of EHR is expected to improve the rate of screening colonoscopies through careful tracking, this is yet to be proven. To compare the rate of screening colonoscopies between EHR and non-EHR implemented clinics across different genders, races and ethnicities and to compare the screening rates in EHR implemented clinics across different regions, specialty clinics and insurances. We performed a retrospective analysis of the limited access dataset from the National Ambulatory Medical Care Survey from 2003 (when EHR was introduced) to 2009. All patients above 50 years of age were included in the analysis. Multivariate logistic regression was used to investigate discrepancies in the rate of colonoscopies based on gender, race, ethnicity, region, type of insurance and type of specialty clinic. All statistical analysis was performed using SAS. 98,104 patients above 50 years of age were included in the study. Overall, there was no significant difference in the rate of colonoscopies among patients visiting EHR clinics compared to non-EHR clinics [OR 0.93, 95% CI (0.73-1.19)]. On sub-group analysis, there was no significant difference in the rate of colonoscopies between EHR clinics and non-EHR clinics based on gender or ethnicity. However, African Americans had a significantly lower rate of colonoscopy in EHR clinics [OR 0.47, 95% CI (0.22-0.98)] compared to non-EHR clinics (Table). Among the patients in EHR clinics who underwent colonoscopy, there was no significant difference in the colonoscopy rates based on region or patient's insurance. However in the same population, colonoscopy rate was significantly lower in Internal-Medicine clinics [OR 0.49, 95% CI (0.25-0.96)] compared to Family-Medicine clinics.TableColonoscopy Rates in EHR vs Non-EHR Implemented Clinics Based on Race and EthnicityCharacteristics (Age >50)EHR use, % of all visitsNon EHR use, % of all visitsAdjusted odds ratio (95% CI)*Hispanic Colonoscopy No41.658.41 (Reference) Colonoscopy Yes48.251.81.16 (0.55 to 2.45)Non Hispanics Colonoscopy No44.355.71 (Reference) Colonoscopy Yes41.358.70.80 (0.62 to 1.05)Caucasians Colonoscopy No43.556.41 (Reference) Colonoscopy Yes43.256.80.91 (0.71 to 1.16)African Americans Colonoscopy No38.961.21 (Reference) Colonoscopy Yes30.269.80.47 (0.22 to 0.98) Open table in a new tab Implementation of EHR in ambulatory care does not change the rate of screening colonoscopy. This is consistent with previously published data on EHR with regard to other areas of preventative care. Our results highlight the need for improving EHR features to prompt physicians to obtain colonoscopies. Lower rates of colonoscopy in African American patients points to a need for better utilization of primary care resources for this subgroup. Our study also shows that there is a need for improving colonoscopy rates in Internal-Medicine clinics when compared to Family-Medicine clinics.