The Better Health study focused on a 12-month window spanning 2009 and 2010, and also followed trends over a three-year period. The study also measured achievement by age, gender and racial and ethnic categories as well as language preference and estimated patient income and education. The locally vetted national standards for care included timely measurements of blood sugar, management of kidney problems, eye examinations, and vaccinations for pneumonia. Outcome measures included meeting national benchmarks for blood sugar, blood pressure and cholesterol control, as well as achieving a non-obese Body Mass Index and avoidance of tobacco use. Patients who made at least two visits to the same primary care practice within a single year were included. The researchers reported results for individual standards as well as separate composite standards for care and outcomes. In the future they will be also developing metrics for patient satisfaction, as well as possibly adding childhood obesity and hypertension.

The study’s findings were striking – even after researchers statistically accounted for differences between EHR and paper-based practices in the characteristics of their patients.

• Standards of Care: Nearly 51 percent of patients in EHR practices received care that met all of the endorsed standards. Only 7 percent of patients at paper-based practices received this same level of care – a difference of 44 percentage points. After accounting for differences in patient characteristics, EHR patients still received 35 percent more of the care standards.
• Patient Outcomes: Nearly 44 percent of patients in EHR practices met at least four of five outcome standards, while just under 16 percent of patients at paper-based practices had comparable results. After accounting for patient differences, the adjusted gap was 15 percent higher for EHR practices.
• Trends Over Time: After accounting for patient differences, EHR practices had annual improvements in care that were 10 percent greater than paper-based practices as well as 4 percent greater annual improvements in outcomes.
• Performance Across Insurance Types: Patients in EHR practices showed better results, including improvements over time, in both standards of care and outcomes across all insurance categories – commercial, Medicare, Medicaid and uninsured.

“These results support the expectation that federal support of electronic health records will generate quality-related returns on our investments,” said David Blumenthal, M.D., M.P.P., professor of medicine and health care policy at Harvard Medical School and past National Coordinator for Health Information Technology. “I am especially pleased that the benefits reported in this investigation spanned all insurance types, including Medicaid and uninsured patients, since it is essential that the modern information technologies improve care for all Americans, including our most vulnerable citizens.”

“Cleveland stands as a pioneer in the burgeoning movement to leverage local resources and federal reform opportunities to improve health care quality,” said Anne F. Weiss, M.P.P., who leads efforts to improve the quality of American health care at the Robert Wood Johnson Foundation. “Electronic health records alone cannot solve the nation’s health care quality problems, but they are an important part of the fix. Cleveland’s use of electronic health records is a model for all health care organizations working to implement health reform.”

“Better Health seeks to improve the value of health care for all of the region’s residents and those who pay for their care,” said David L. Bronson, MD, FACP, president of Cleveland Clinic Regional Hospitals and President-elect of the American College of Physicians. “As the program moves forward, we expect that EHR-based sharing of information across different health care systems, and with our patients, will help us to keep our patients healthier and foster more discriminating use of expensive resources, such as our emergency departments and hospitals.”

This perspective is also echoed by other national leaders as well. Not only do such collaborations enhance care and outcomes, but they also provide rich opportunities to test the impact of different approaches and innovations. As Dr. Carolyn Clancy, M.D., director of the federal Agency for Healthcare Research and Quality, explained: “The results of this study support both the value of electronic health records and community-based partnerships to improve quality of care.”

Brian Ahier works as Health IT Evangelist for Information Systems at Mid-Columbia Medical Center. He is a City Councilor in The Dalles, Oregon and also serves on the Board of Mid-Columbia Council of Government, and Q-Life, an intergovernmental agency providing broadband capacity to the area. He blogs regularly at Healthcare Technology & Government 2.0.