Electronic Records Increase Preventive Testing, Study Says

9 Mobile EHRs Compete For Doctors' Attention

Practices with electronic medical records (EMRs) tend to order more mammograms and other preventive health services for women than those that still keep records on paper, according to newly published research. The more sophisticated the EMR, the more tests ordered.

In a study published in the Journal of the American Medical Informatics Association (JAMIA), a multidisciplinary team from the University of Cincinnati measured 11 variables, based on preventive care recommended by the U.S. Department of Health and Human Services' Office on Women's Health. "For seven of the 11 healthcare outcomes studied, the presence of some type of EMR system was important," said the study, which first appeared online last fall but was in the February print edition of JAMIA.

The researchers presented an earlier version of their study as an unpublished poster at the 2011 International Society for Pharmacoeconomics and Outcomes Research annual meeting, they said.

[ Should you trust the information in electronic health records? Read EHR Accuracy Remains Problem, CHIME Says. ]

The incidence of breast and pelvic exams, Pap tests, mammography, cholesterol tests, bone mineral density (BMD) and chlamydia screening all went up "significantly" in the presence of even a minimally implemented EMR. As EMR functionality increased, so did usage of these tests, the Cincinnati researchers found. "The key independent variable was the level of EMR system sophistication," they said.

"Across the providers [studied], 29.23%, 49.34%, 15.97%, and 5.46% had no, minimal, basic, and fully functional EMR systems, respectively," the researchers said, using the classifications in the annual National Ambulatory Medical Care Survey (NAMCS), as compiled by the U.S. Centers for Disease Control and Prevention (CDC). They examined data in the 2007 and 2008 surveys. "The breast examination rate was 20.27%, 34.96%, 37.21%, and 44.98% for providers without or with minimal, basic, and fully functional EMR systems, respectively," the JAMIA paper said.

However, EMRs did not seem to affect rates of testing blood pressure, nutrition counseling, diet and exercise counseling, or administration of flu vaccines.

What is not known from this study is whether the level of EMR functionality affects quality of care or health status from preventive screenings, because the NAMCS data do not indicate whether a patient actually got the recommended care or if a physician merely placed an order. "It cannot be assumed that patients necessarily followed through with tests and examinations, let alone followed advice on diet and exercise," the researchers noted.

Still, they concluded that their findings "strongly suggest that EMR systems have a positive impact on preventive women's healthcare. The use of a national database along with advanced statistical techniques allow for confidence in this conclusion."

The Cincinnati team did allow that they were working with rather old data, from 2007 and 2008, which were the most recent NAMCS statistics available when putting together their analysis. "However, because of the fast-paced development and adoption of EMR system technology, the results of this study will become dated fairly quickly," they said, noting that the CDC's National Center for Health Statistics reported in 2011 that 57% of office-based physicians had some form of EMR.

"Guidelines for women's health also change periodically depending on the latest research findings," they added.

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