Electronic Health Records Improve Care of Patients with Medical Conditions

Objectives: The emergence of health information technology provides a opportunity to improve health information exchange between medical and dental providers to improve the quality and safety of care. The goal of this proposal is to evaluate the effectiveness and utilization of reminders in accessing personalized guidelines within integrated health records to improve the quality and safety of dental care for patients with chronic medical conditions. Methods: This 3-arm, 2-year prospective, group-randomized clinical trial, was implemented within 17 of HealthPartners dental clinics to evaluate different interventions to implement reminders and decision support within an integrated EHR system and compare them to usual care. The interventions are either: 1) a point-of-care reminders from the electronic medical record(EMR) to the dentist's electronic dental record(EDR) and 2) reminder letters from the EMR to patients. Patients included those with diabetes mellitus, congestive heart failure, pulmonary disease, and xerostomia. Results: A population of over 4000 subjects and 47 dentists at HealthPartners were studied with regard to utilization of care guidelines using this system. Analysis of data to date suggest that 1) Reminder alerts to both dentists in the EDR and to patients increase utilization of care guidelines; 2) Both EDR provider alerts and patient letters have a generalizable effect of increasing the rate at which providers reference care guidelines for all patients compared to usual care and; 3) Automated provider alerts in the EDR are more effective at encouraging the use of care guidelines than personalized letters sent to patients. Conclusions: This research provides practical health information technology strategies that use integrated electronic health records to improve clinical decision-making and quality and safety of care for patients with chronic medical conditions. This project was supported by AHRQ R18 HS017270.