The adoption of an electronic health record did not improve A1c values in Type 2 diabetes

Abstract

background A major justifcation for the clinical adoption of electronic health records (EHRs) was the expectation that it would improve the quality of medical care. No longitudinal study has tested this assumption. Objective We used hemoglobin A1c, a recognized clinical quality measure directly related to diabetes outcomes, to assess the effect of EHR use on clinical quality. Methods We performed a fve-and-one-half-year multicentre longitudinal retrospective study of the A1c values of 537 type 2 diabetic patients. The same patients had to have been seen on at least three occasions: once approximately six months prior to EHR adoption (before-EHR), once approximately six months after EHR adoption (after-EHR) and once approximately fve years after EHR adoption (fve-years), for a total of 1,611 notes. results The overall mean confdence interval (CI) A1c values for the beforeEHR, after-EHR and fve-years were 7.07 (6.91-7.23), 7.33 (7.14-7.52) and 7.19 (7.06-7.32), respectively. There was a small but signifcant increase in A1c values between before-EHR and after-EHR, p =.04; there were no other signifcant differences. There was a signifcant decrease in notes missing at least one A1c value, from 42% before-EHR to 16% fve-years (p