Using Electronic Health Records to Improve Outpatient Diabetes Care

Abstract

Early versions of electronic health records (EHRs) were developed in the 1980s. The potential to use such technology to improve care—especially preventive care and outpatient chronic disease care—has been widely assumed since the publication of two landmark Institute of Medicine reports in 1992 and 1994.1,2 However, nearly two decades later, the potential for EHR technology to improve chronic disease care—in particular, care of adults with type 2 diabetes—remains unrealized. The unfulfilled potential is partially related to low levels of outpatient EHR use. As recently as 2008, only ~ 13% of primary care physicians (PCPs) used basic EHR systems, and only 4% reported using fully functional systems.3 Recent federal policies provide incentives for and subsidize the use of outpatient EHRs and are likely to accelerate the use of such systems in the near future. However, other concerns remain.4 Patients appear positively disposed to their providers' use of EHRs,5 but provider reactions have been less enthusiastic. Many early adopters of EHRs reported decreased practice revenue, disrupted clinic workflows, and transient deterioration in the office environment.6,7 Improvement of quality of care, a much anticipated result of the substantial financial investments needed to impel EHR use, has been slow to materialize. Some early reports even noted deterioration in care after EHR implementation.8–11 More recent reports reiterate that the effect of EHR systems on quality is marginal and assert that use of specific features of EHRs may be a better predictor of improved quality than simple implementation of basic systems.12,13 What about diabetes care specifically? What evidence do we have that EHR use or …