June 6, 2014
Patient centered medical homes that use electronic health records improved the care of patients "significantly" over time compared to primary care physicians who used paper records or who used EHRs but weren't affiliated with a medical home, according to a new study in the Annals of Internal Medicine.
The researchers studied 675 primary care physicians (PCPs) in 312 practices and 143,489 patients in Hudson Valley, New York over a three-year period. They compared the quality of care of 10 different measures for patients of medical homes—all of which used EHRs—patients of non-medical home PCPs who used EHRs and independent PCPs who used paper records.
The medical home group improved significantly more over time than either the paper record or the EHR-only group for four out of the 10 measures, such as colorectal cancer screening and testing for patients with diabetes. It was unclear why the improvements manifested for only four measures, however.
In a corresponding editorial, Robert Reid, M.D., a senior investigator at Group Health Research Institute in Seattle, and Michael Parchman, M.D., also of Group Health, noted that EHRs alone may be insufficient to improve care.
"Improving primary care requires continual attention to the complex interplay of clinicians, staff, patients and information systems embedded in a busy practice setting with many competing demands," Reid and Parchman wrote. "Implementing the [patient centered medical home] is an opportunity to take a unified approach to quality improvement—an approach that has the potential to yield more benefits than EHR implementation alone."
EHRs are an important element of newer clinical care models, such as patient centered medical homes and accountable care organizations (ACO), both of which are growing. However, at least one study has reported that EHRs are not meeting the needs of some ACOs, causing the providers to turn to third-party vendors.
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