Demonstrating Quality

Gienna Shaw, for HealthLeaders Media , October 13, 2011
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This article appears in the October 2011 issue of HealthLeaders magazine.

Editor’s note: This piece is based on Gienna Shaw’s Sept. 6 online column, “Tech That Powers Quality Standards.” To see the column, visit, click the Technology tab, then the Technology Input link.

A study published in the New England Journal of Medicine is among the first to put hard numbers to the benefits of electronic health records. Researchers looked at four national quality standards, including: eye exams; pneumonia vaccinations; outcome measures such as blood sugar, blood pressure, and cholesterol control; and patient-driven issues such as obesity and smoking.

Nearly 51% of patients in EHR practices received care that met all four quality standards, compared to just 7% of patients at paper-based practices. Nearly 44% of patients in EHR practices met at least four of five outcome standards, compared to about 16% of patients at paper-based practices.

But as the study’s lead author, Randall Cebul, MD, said in an interview this week, “51% is 49% short of ideal.”

So what are the next steps? And how can health information technology get us there?

Compliance and engagement

One finding of the research was that the benefit of electronic records was greater for care standards than it was for outcomes. And care standards that are largely patient-controlled—such as smoking and obesity—have been particularly troublesome.

“I guess it takes a village to attack all of the more behavioral-related and adherence-related issues that are most relevant to patients when they’re living outside of the doctor’s office, which is virtually 100% of the time,” said Cebul, who is the director of Better Health Greater Cleveland, a nonprofit healthcare alliance focused on improving the health of chronic disease patients in Northeast Ohio.

Personal health records can help, he said.
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