The EHR has had a monumental impact on how we practice medicine. While I have been a proponent of the EHR, and have envisioned a new level of safety and utility in serving the needs of our patients, there has not been a lot of data to support its benefits, since we are early on in the game.
However, three recent EHR studies published recently demonstrated cost savings, utility of diagnosis, and improved safety in patient care. In the February issue of The American Journal of Medicine, researchers studied how to best optimize EHR utilization. The study was set up to reduce overutilization of laboratory testing in the hospital by eliminating a function that allowed providers to automatically order daily lab tests without review. Data was compared pre- and post-implementation and providers were surveyed about their experience with the change.
The researchers examined nearly 1.3 million tests on over 92,000 patients. Prior to the intervention, automated target test ordering accounted for 33 percent of the tests ordered. After the intervention, researchers observed a reduction of 8.5 percent in the tests ordered. For the tertiary care academic center observed in the study, researchers estime $300,000 was saved over the two years that the intervention took place. The researchers identified future areas of study by including the additive effects of education and real-time decision support of these types of EHR interventions.
Another benefit the recent data show is utility of diagnosis. In the April issue of the Journal of Biomedical Informatics, researchers published an EHR data mining study that began in 2012. The researchers were looking for a more accurate and less expensive way to identify people with undiagnosed Type 2 diabetes. The research team examined the EHRs of nearly 10,000 people from hospitals, clinics, and private practices, masking patient identity in all cases.
Half of the data was used to develop an algorithm that allowed them to predict the likelihood of an individual having diabetes, and that algorithm was tested on the other half of the data. What they also found were a whole host of other risk factors that were as important as the “traditional” risk factors for diabetes. These include (increased risk):
• Sexual and gender identity disorders (130 percent same as hypertension)
• Viral infections and chlamydia (82 percent)
• History of colitis, enteritis, and gastroenteritis (88 percent)
Considering that having a high body mass index also lands an individual at a 101 percent increased risk for Type 2 diabetes, these new risk factors are important. It worked both ways. Lower risk for diabetes was observed among migraine sufferers, as well as people taking anti-anxiety and anti-seizure medication.
The potential benefit to this research is that one in four people don’t know that they have diabetes. By improving identification of risk factors, we can put more people forward for screening, and get them into treatment earlier. This also has potential significant cost savings implications.
Finally, Healthcare IT News reported on a study funded by the Agency for Healthcare Research and Quality, published recently in the Journal of Patient Safety. They set out to look at rate of adverse events in the hospital among patients covered by a full EHR and those that were not. Using Medicare Patient Safety Monitoring System data on cardiovascular, pneumonia and surgery patients, they looked closely at the occurrence of 21 events in four clinical domains: hospital acquired infections, adverse drug events, general events (e.g., falls and pressure ulcers), and post-procedural events.
The research covered 45,000 patients for nearly 350,000 adverse events. While the sample was small — of these patients, 13 percent were fully covered by an EHR, the results did seem promising. Among all patients, the adverse occurrence rate was 2.3 percent. The researchers found that patients fully covered by an EHR had 17 to 30 percent lower odds of any adverse event.
EHRs are getting much more robust with decision support tools and interaction checks, which can be expected to support reductions in adverse events among our patients. These examples show the promise of the EHR in cost savings, diagnosis, and patient safety. Given these findings, it’s possible that future research into the effects of the EHR will discover many benefits, and pitfalls, which will become more accessible as larger amounts of electronic health data becomes available to researchers. This is an interesting time to be practicing medicine, we are in an age of data accumulation and innovation never seen before. It is my hope that we will be able to use this data to improve care. I believe that the promise of the EHR will continue to help use learn more about patients on many different levels as the technology is refined.