There have been a number of research studies published that question the value of Electronic Health Records (EHRs), particularly as it pertains to improving quality of care and ultimately outcomes. Chilmark has always viewed these reports with a certain amount of skepticism. Simple logic leads us to conclude that a properly installed (including attention to workflow and thorough training) of an enterprise software system such as an EHR will lead to a certain level of standardization in overall process flow, contribute to efficiencies and quality in care delivery and ultimately lead to better outcomes. But to date, there has been a dearth of evidence to support this logic, that is until this week.
Last week the New England Journal of Medicine published the research paper: Electronic Health Records and Quality of Diabetes Care, which provides clear evidence, albeit a little fuzzy around the edges, that physician use of an EHR significantly improves quality metrics over physicians who rely on paper-based medical record keeping processes.
The research effort took place in Cleveland as part of Better Health Greater Cleveland from July 2009 till June 2010 and included 46 practices representing some 569 providers and over 27K adults with diabetes who visited their physician at least twice during the study period. Several common quality and outcome measures were used to assess and compare EHR-based care to paper-based. On composite standards of quality, EHR-based practices performed a whooping 35% better than their paper-based counterparts. On outcome measures, which are arguably more difficult for physicians as patients’ actions or lack thereof are more integral to final outcomes, EHR-based practices still outperformed their paper-based peers by some 15%. The Table below gives a more detailed breakout.
There remains an unhealthy level of skepticism in the market as to whether or not consumers will use a personal health record (PHR). While a certain level of skepticism is healthy in any market, the level to which it is laid towards PHRs is unwarranted and likely more a function of ignorance then malicious intent. Following is a brief PHR case study that provides validity to the mantra that a patient who is provided access to their personal health information (PHI) via a PHR can become a more engaged patient in self-managing their health. What is particularly striking about this story is that it is does not take place in middle-class America, where many have targeted their PHR initiatives, but rather among the urban poor.
Last week, I met with Dr. Nunlee-Bland, Director of Howard University Hospital’s (HUH) Diabetes Treatment Center, who graciously provided the context and content for this remarkable story.
Empowering the Urban Poor to Self-Manage Their Diabetes:
In 2008, HUH received a grant from the Dept of Health, DC to launch a diabetes treatment program primarily targeting urban poor. As part of this grant, HUH launched a PHR initiative creating a patient portal using NoMoreClipboard (NMC), linking NMC to their clinical diabetes EHR, CliniPro from NuMedics. The PHR provides patients with access to their problem list, vitals (height, weight, blood pressure, BMI), medication lists, basic lab results, A1C results (can be charted for track and trend) and basic demographic information. While Dr. Nunlee-Bland stated that HUH has no reason not to provide patients with full access to all PHI, they have purposely kept the PHR simple and focused on the treatment of diabetes.
We have just opened the 2010 DiabetesMine Design Challenge. This year, we’ll be selecting THREE Grand Prize winners to EACH receive $7,000 in cash and a support package to help winners realize and commercialize their design ideas.
There’s also $1,000 each for the Most Creative Idea and Kids’ Categories.
And… Community Voting! The community will select the contest finalists in open voting taking place in mid-May.
So… Do you have an idea for an innovative new diabetes device or web application? The contest is open to ANYONE with a good idea: patients, parents, startup companies, design & medical students, developers, engineers, etc.
Please have a look at www.diabetesmine.com/designcontest
As we work to change health care in America, we must recognize the need to dramatically change diabetes. Twenty-four million Americans have diabetes at a cost to our nation of an estimated $218 billion for diabetes and pre-diabetes, according to a series of studies recently published in Population Health Management. Imagine the effects diabetes will have on our health and economy in the future if we don’t take action now. The prevalence and economic burden of undiagnosed and pre-diabetes make the case for the importance of policies that promote early diagnosis and prevention. About 25 percent of Americans with diabetes aren’t even aware they have the disease. And, those with undiagnosed diabetes result in $18 billion in health expenses, or $2,864 per person each year, according to one of the studies mentioned above.
July 14 at 4 pm ET, 14,000 people with diabetes are going to test their blood sugar simultaneously and share their results online to help raise diabetes awareness. People with diabetes have to test their blood sugar as part of their daily routine: it’s like drinking water or brushing your teeth. Participating is easy: if you are a member of TuDiabetes or EsTuDiabetes, click on the home page banner and share your reading; if you have a Twitter account, post your reading on Twitter (use the #14KPWD hashtag) and link back to: http://14kPWD.org; if you prefer, update your status on Facebook or your preferred social network, linking back to: http://14kPWD.org. If you are a few minutes late, however, or are able to post your blood sugar reading earlier or later that day, it’s OK. What really matters is that you test your blood sugar regularly. If you don’t have diabetes, just tell someone who does to test and share on July 14.