Electronic Health Records in Four Community Physician Practices: Impact on Quality and Cost of Care

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Health information technology (HIT) has been seen as a way to lower the cost of patient care while improving the quality. People who advocate HIT have suggested that technology such as clinical decision support CDS have many benefits including an increase in adherence to guidelines, improvements in health status, and lower costs. Electronic health records (EHRs) have been one of the most discussed forms of HIT and the Institute of Medicine (IOM) has given eight core functionalities that these systems should have. Some of these functionalities include:

  • Health information and data storage
  • Management of lab and imaging tests results
  • Electronic ordering
  • Clinical decision support
  • Interoperability
  • Administrative processing for things such a billing

There have only been a few studies that have shown the impact of HIT on cost and quality of care. A study was done to analyze the impact of an EHR implementation in four private practice settings. [1]


Quantitative and qualitative data were collected for this study. Telephone calls and site visits were used to collect the qualitative study. Various technical functionalities were discussed including: diagnosis, lab, radiology, and decision support, reminders and patient education capabilities. Barriers faced during implementation were also discussed. Differences in quality of care and costs were measured before and after EHR adoption to collect quantitative data. The specific diseases that were focused on in this study were hypertension, hyperlipidemia, diabetes, and other heart conditions. The cost per care episode over a year and the rate of clinical guideline adherence were used to measure the differences in cost & quality.


The implementation of the EHR had a positive impact on the quality of care regarding hypertension and hyperlipidemia, but no impact on diabetes and coronary artery disease. There were no qualifiable impressions on the short-term cost per episode was found. Dialogs with the study practices discovered that the timing and inclusiveness of EHR implementation varied from practice to practice


This study was able to show that adherence to guidelines increased with the use of EHRs. More research is needed to study the impact on quality and the cost of care over a longer time period.

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Electronic health records improve the quality of care in underserved populations: A literature review


  1. Electronic Health Record in Four Community Physician Practices : Impact on Quality and Cost of Care W. Pete Welch, Dawn Bazarko, Kimberly Ritten, Yo Burgess, Robert Harmon, Lewis G. Sandy Journal of the American Medical Informatics Association May 2007, 14 (3) 320-328; Retrieved on November 4, 2015 from http://jamia.oxfordjournals.org/content/14/3/320 DOI: 10.1197/jamia.M2125