WEDNESDAY, Aug. 31 (HealthDay News) -- New research suggests
that using electronic medical records instead of paper files could
greatly improve care for diabetic patients by boosting
Diabetic patients "did better and improved faster" at various
kinds of medical clinics that had switched to e-records, said study
author Dr. Randall D. Cebul, a professor of medicine at Case
Western Reserve University in Cleveland. "The differences were
However, there are caveats to the study. The research doesn't
prove that electronic records directly improved patient care; other
factors could explain the difference. And it can be costly for
clinics to convert to electronic records, although many may be able
to get financial incentives from the federal government.
Cebul said the findings are strong. He acknowledged, however,
that clinics often failed to fully follow guidelines about care for
diabetics, even when they used electronic records.
Converting to electronic records may seem like a slam dunk when
it comes to patient care. Proponents say they make it easier for
doctors to communicate with patients and with one another. The
records are also supposed to cut down on medical errors by doing
things like providing warnings about medication allergies.
The Obama Administration is so confident that a move to
e-records will improve care and cut costs that it made the shift a
key part of health care reform efforts. Still, doctors seem slow to
adopt the technology: A HealthDay/Harris Interactive poll conducted
a year ago found that fewer than 1 in 10 adults used email to
communicate with their physician.
And researchers have had trouble confirming that electronic
records actually boost medical care. "In a lot of studies, there
hasn't been enough change that they can say it's improved things,"
noted Richard Hillestad, a senior principal researcher who studies
medical record-keeping at the non-profit research group the Rand
In the new study, researchers analyzed the medical records of
more than 27,000 adults who received care for diabetes at clinics
in the Cleveland area. They wanted to see if there was any
difference between results at clinics that had adopted electronic
records and those that hadn't.
The study findings appear in the Sept. 1 issue of the
New England Journal of Medicine.
After adjusting their statistics so they wouldn't be thrown off
by factors such as differences in medical conditions among
patients, the researchers found that people who visited clinics
with electronic records were more than a third more likely to have
received care that met all four clinical benchmarks. The benchmarks
require that patients undergo eye examinations, pneumococcal
vaccinations, kidney management and measurement of glycated
hemoglobin (also known as HbA1c, a means of tracking blood sugar
Patients at clinics with electronic records were also 15 percent
more likely to meet all five benchmarks for their personal health,
including specific ranges for blood pressure, cholesterol and
However, it's possible that the clinics with paper records
simply provided worse care in general -- their decision to not move
to electronic records could be a sign that they're behind the times
in other ways. But Celub said the evidence suggests that is not the
He acknowledged that the study does not use the prospective
approach that's considered the gold standard in medical research.
Instead, it looked back at what happened to the patients instead of
randomly assigning clinics to use electronic or paper records and
then tracking their progress. "It's not a randomized controlled
trial," he said, "but that will never happen."
Why? Because physicians won't want to be stuck with paper
records. "How many doctors would like to be randomly assigned to
stay in the dark for three years?" he asked. "Nobody."
The study findings also reveal how few patients met all the
standards. Of those who went to clinics with electronic records,
the unadjusted statistics show that just 51 percent met all four
benchmarks for care, compared to only 7 percent of those at clinics
that relied on paper. And just 44 percent of those at the
electronic-record-using clinics met four out of five benchmarks for
how they were doing medically, compared to only 16 percent for
those at clinics that relied on paper.
"We have a long way to go," Cebul said.
Still, Rand Corp.'s Hillestad said the study does suggest that
electronic records have value in the treatment of people with
chronic illnesses. "If you can start to see evidence that
electronic health records are improving the care and cost of
chronic illness, that will be a really big step."
There's more on personal health records at the
U.S. National Library of Medicine.