Effect of electronic health records in ambulatory care: retrospective, serial, cross sectional study

• Published in: BMJ Vol. 330; no. 7491; pp. 581 - 584
• Main Authors: Garrido, Terhilda, Jamieson, Laura, Zhou, Yvonne, Wiesenthal, Andrew, Liang, Louise
• Format: Journal Article
• Language: English
• Published: London British Medical Journal Publishing Group 12.03.2005; British Medical Association; BMJ Publishing Group LTD; BMJ Publishing Group; BMJ Publishing Group Ltd
• Edition: International edition
• Subjects: Age Factors; Ambulatory care; Ambulatory Care - standards; Ambulatory Care - utilization; Biological and medical sciences; Colorado; Cross-Sectional Studies; Electronic health records; Electronic records; General aspects; Health care industry; Health care quality; Humans; Information In Practice; Information retrieval; Medical practice; Medical records; Medical Records Systems, Computerized; Medical sciences; Physicians; Primary health care; Quality of Health Care; Quality of service; Radiology; Radiology Department, Hospital - utilization; Regional health planning; Remote Consultation; Retrospective Studies; Telephones; Colorado; Medicine; Cross sectional study; Electronics; Ambulatory; Retrospective; Public health; Care
• ISSN: 0959-8138; 0959-8146; 1468-5833; 1756-1833
• DOI: 10.1136/bmj.330.7491.581

Abstract Objective To evaluate the effect of implementing comprehensive, integrated electronic health record systems on use and quality of ambulatory care Design Retrospective, serial, cross sectional study. Setting Colorado and Northwest regions of Kaiser Permanente, a US integrated healthcare delivery system. Population 367 795 members in the Colorado region and 449 728 members in the Northwest region. Intervention Implementation of electronic health record systems. Main outcome measures Total number of office visits and use of primary care, specialty care, clinical laboratory, radiology services, and telephone contact. Health Plan Employer Data and Information Set to assess quality. Results Two years after electronic health records were fully implemented, age adjusted rates of office visits fell by 9% in both regions. Age adjusted primary care visits decreased by 11% in both regions and specialty care visits decreased by 5% in Colorado and 6% in the Northwest. All these decreases were significant (P < 0.0001). The percentage of members making ≥ 3 visits a year decreased by 10% in Colorado and 11% in the Northwest, and the percentage of members with ≤ 2 visits a year increased. In the Northwest, scheduled telephone contact increased from a baseline of 1.26 per member per year to 2.09 after two years. Use of clinical laboratory and radiology services did not change conclusively. Intermediate measures of quality of health care remained unchanged or improved slightly. Conclusions Readily available, comprehensive, integrated clinical information reduced use of ambulatory care while maintaining quality and allowed doctors to replace some office visits with telephone contacts. Shifting patterns of use suggest reduced numbers of ambulatory care visits that are inappropriate or marginally productive.