Healthcare providers who participate in Better Health Greater Cleveland continued to improve the quality of care they provide patients with common chronic conditions last year — thanks, in part, to electronic medical records.
Later this year, doctors’ offices and hospitals will begin receiving more than $20 billion in federal and state stimulus money when they adopt electronic medical record technologies.
In the meantime, all three federally qualified health centers in Cuyahoga County — Care Alliance, Neighborhood Family Practice and Northeast Ohio Neighborhood Health Service Inc. — are using stimulus dollars from a separate pot to install electronic record systems.
“The practices that do not have electronic health records are typically disadvantaged in two ways,” said Dr. Randall Cebul, director of Better Health and a professor of medicine and epidemiology at Case Western Reserve University in Cleveland. “They don’t have the guidance of the electronic medical record. And typically, they are caring for patients who are less well-off.”
The fifth Community Health Checkup report by Better Health compared how often patients with diabetes, heart failure and high blood pressure received recommended care and reached clinical goals at nearly 50 participating medical practices across Northeast Ohio with results from other local medical practices. It didn’t matter whether the practices had paper or electronic records.
The Northeast Ohio partnership that’s part of the Aligning Forces for Quality initiative found that:
- Almost half of 26,000 patients with diabetes at participating primary care practices received all of the recommended tests for kidney function, cholesterol and blood-sugar control, and immunizations (for pneumonia) last year — an improvement of nearly 10 percentage points from 2007.
- Better Health’s primary care physicians’ use of recommended treatments equaled recently published results of cardiologists in specialty clinics nationwide. In addition, four out of five of 5,200 local heart failure patients received all four recommended evaluation and monitoring standards, including the use of tests such as echocardiograms to evaluate the heart’s pumping function.
- More than two-thirds of 97,900 local patients with hypertension controlled their blood pressure in 2009 — a level significantly higher than the national rate of 50 percent, as reported this spring in the Journal of the American Medical Association. “Control” is having a blood pressure better than the goal of 140/90.
A Deep-dive Into Specialty Pharma
A specialty drug is a class of prescription medications used to treat complex, chronic or rare medical conditions. Although this classification was originally intended to define the treatment of rare, also termed “orphan” diseases, affecting fewer than 200,000 people in the US, more recently, specialty drugs have emerged as the cornerstone of treatment for chronic and complex diseases such as cancer, autoimmune conditions, diabetes, hepatitis C, and HIV/AIDS.
“We were especially pleased to see continued improvements in our diabetes results and our achievement among patients with heart failure,” Cebul said. “While our hypertension results exceeded the 50 percent goal set for the nation in its Healthy People 2010 report, we also see considerable variation across sites and a lot of room for improvement.”
Better Health’s results highlight the role of electronic medical records in improving the region’s health. Patients cared for at sites that have traditional paper charts tended to do worse and improve at slower rates than patients with electronic medical records, according to a release on the health partnership’s report. One likely reason? Electronic records are easier for doctors to access.
“Electronic health record systems provide tools for physicians to increase the likelihood that their patients receive the right care at the right time,” said Dr. Anil Jain, senior information technology executive at Cleveland Clinic, in Better Health’s release. “In addition, clinical practice leaders can use these tools to identify changes they can make in their medical offices to do a better job.”
Though Cleveland Clinic, MetroHealth System and Kaiser Permanente Ohio — all Better Health partners — have state-of-the-art electronic record systems, their records can’t be shared across the institutions, Cebul said. That is expected to change this year, he said.
Jean Therrien, executive director of Neighborhood Family Practice and a member of Better Health’s leadership team, used stimulus money aimed at capital improvements to buy electronic health record technology for her federally qualified health center on Cleveland’s West Side.
“Our improvements in diabetes have been quite gratifying,” Therrien said in the Better Health release, “but they will accelerate when we have our electronic health records in place later this year.”
Better Health doctors get together twice a year to share best practices gleaned from their electronic records. “We share the processes that have resulted in the greatest improvements in outcomes,” said Dr. Christopher Hebert, associate medical director for quality at Kaiser Permanente Ohio and leader of Better Health’s Learning Collaborative, in the release.
“Having the same data from all partner sites is invaluable for identifying the best performers,” Hebert said. “No longer can practices simply assert their superiority, and our partners welcome the chance to learn from others.”
Better Health also is working to ensure high-quality care for all patients. Although most groups of patients showed improvement, diabetic outcomes continued to be worse, and blood pressure achievement was lower for the region’s patients who are non-white, poorer, less well-educated and uninsured.
