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Diabetes Care Improved and Costs Reduced with EHRs

by Margaret Schulte, consultant, HIMSS EHR Value Suite Collection


According to the American Diabetes Association (ADA), about one of every three Medicare dollars is spent providing diabetes care. Diabetes was responsible for $245 billion in costs to the U.S. economy in 2012, a cost that had increased by 41 percent over the previous five years. Of the $245 billion, $176 billion is due to the cost of medical care; $69 billion is due to lost productivity. (ADA, 2013)

Nearly 30 million people in the U.S. live with diabetes and another 86 million are pre-diabetic.  About 200 people a day have amputations as a result of diabetes and 136 enter end-stage kidney disease. (ADA, 2013) The data on diabetes in the U.S. highlight the costly impact this chronic condition has on the U.S. economy, as well as the need to focus on improving the health of the diabetic population. With the implementation of electronic health records (EHRs) in healthcare systems throughout the U.S., providers point to the advances these systems have made in improving care and outcomes.

The HIMSS EHR Value Suite Collection contains over 1,800 cases, many of which reveal how the availability of EHRs have contributed to better diabetes care, reduced diabetes-related costs, and improved outcomes. These case results were achieved in a wide range of clinical settings following EHR implementation, and they are reported in a variety of publication types, from peer-reviewed research (level 1 evidence) to vendor-published articles (level 4 evidence). These distinctions in evidence level allow for more targeted research of the data elements in the collection.

The improvements in diabetes care were due to the work of clinical teams, who, once having EHR capabilities, were able to track and analyze data and receive alerts to situations needing early intervention. The teams also used EHRs to improve communication with patients and to engage them in their care. For example, Alta Med reported a diabetes screening rate increase from 69 percent to 90 percent due to the use of an EHR. From a plethora of other cases and stories, the EHR Value Suite Collection reveals further examples, including:

  • For the measure of blood pressure controlled within a target range among patients with diabetes, Ellsworth Medical Clinic reported an increase of 73 percent in 2007 to 97 percent in 2011. 
  • The proportion of pre-diabetic patients developing diabetes dropped from 10 percent to 2 percent at Essen Medical Associates. 
  • The Hope Clinic reported in 2014 that 48 percent of its patients had reduced their risk for diabetes. 
  • Over 70 percent of diabetic patients at the Western North Carolina Hypertension Center achieved blood pressure readings of less than 140/90 in 2012.
  • Christiana Care Family Medicine Centers noted that they are able to better engage entire care teams in diabetes care.  
  • University Hospital and Clinics found that with the assistance of EHR functionalities, drug therapy required to lower low-density lipoproteins (LDLs) decreased by 19 percent.

There are over 150 similar examples of improvement in the care of diabetes in the EHR Value Suite Collection. While each example is anecdotal, the number of examples suggest that the U.S. provider community has found the EHR to be an important tool in reducing the incidence of diabetes, better managing the cases that develop, and achieving better outcomes from both a quality and cost perspective. Initial research literature supports what the anecdotal stories suggest. A study by Herrin et al. (2012) titled “The Effectiveness of Implementing an Electronic Health Record on Diabetes Care and Outcomes” used chart audits based on the AMA/Physician Consortium Adult Diabetes Measure Set to find that:

After adjusting for patient age, sex, and insulin use, patients exposed to the EHR were significantly more likely to receive “optimal care” when compared with unexposed patients (p < .001), with an estimated difference of 9.20 percent (95% CI: 6.08, 12.33) in the final year between exposed patients and patients never exposed. Components of the optimal care bundle showing positive improvement after adjustment were systolic blood pressure <80 mmHg, diastolic blood pressure <130 mmHg, aspirin prescription, and smoking cessation. Among patients exposed to EHR, all process and outcome measures except HbA1c and lipid control showed significant improvement.  (Herrin, 2012)

These results provide evidence that the profound problem of diabetes in the U.S. can be more effectively addressed with the EHR and the improved data and communications that it supports.

References

American Diabetes Association. Economic costs of diabetes in the U.S. in 2012. Mar 16, 2013.  Accessed May 8 at http://www.diabetes.org/advocacy/news-events/cost-of-diabetes.html.

Herrin et al. The effectiveness of implementing an electronic health record on diabetes care and outcomes. Health Services Research 2012 Aug;47(4):1522–1540. doi: 10.1111/j.1475-6773.2011.01370.x  Published online Jan 17, 2012.  Accessed May 8, 2016.

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