Effect of electronic health records in ambulatory care: retrospective, serial, cross sectional study

• HIT Description: Electronic Health Record; CPOE More info...
  
• Purpose of Study: Assess the effect of the introduction of a multifunctional EHR on health care utilization and processes of care
  
• Years of study: 1992-2002
  
• Study Design: Time series
  
• Outcomes: processes of care and utilization
  

• Settings: Kaiser Permanente Northwest and Colorado
• Intervention: Multifunctional HER
• Evaluation Method: administrative and medical record data
• Description: Locally developed EHR in Colorado Kaiser EpicCare, and in the Northwest; both systems were multifunctional HIT systems with EHR, CPOE, integrated documentation, and decision support
• Interoperability: Available in all clinical sites of care
• Strategy: qualitative interviews indicated that strong leadership support was kep to successful implementation. Organizational structure supporting free flow of information and efficiency gains was considered key to realizing the benefits of an EHR
• Financial Context: HMO
• System Penetration: Full implementation
• Healthcare Utilization: Ambulatory care services declined in both the Northwest and Colorado, radiology services decreased by 14% in the Northwest, laboratory use decreased by 18% four years after implementation.
• Quality of Care and Patient Safety Outcome: Measures of advice on smoking cessation, cervical cancer screening, or retinal examination in diabetics either were unchanged or improved slightly over time.
• Changes in efficiency and productivity: Postulated gains in efficiency, but no formal analysis was presented.�