New study to use electronic medical records to improve care of patients with diabetes

November 08, 2004

CLEVELAND - Case Western Reserve University, in partnership with the MetroHealth Medical Center and The Cleveland Clinic Foundation, has been awarded a $1.5 million grant from the Agency for Healthcare Research and Quality to evaluate whether advanced technology for record keeping and patient empowerment can improve the care and health outcomes of patients with diabetes. The multi-arm research project will take advantage of the state-of-the-art electronic medical record (EMR) system used by both MetroHealth and The Cleveland Clinic to study the system as it is currently used and to examine it with enhancements for physicians and patients. The five-year grant is part of a $139 million national package of grants and contracts awarded by the Agency for Healthcare Research and Quality, part of the U.S. Department of Health Human Services, to promote the use of information technology to improve the nation's health care system.

Randall D. Cebul, M.D., professor of medicine and director of the Center for Health Care Research and Policy at Case and MetroHealth, is the principal investigator of the project.

"We are conducting this study because strong evidence demonstrates that better processes of care lead to improved outcomes. The question is, what is the best means to use revolutionary new health technologies to improve decision-making and outcomes? That is what we hope to answer," said Cebul.

C. Martin Harris, M.D., chief information officer and chairman of the Information Technology Division at The Cleveland Clinic, is the co-principal investigator. "This partnership is a significant one," Harris said. "It gives several Cleveland institutions the opportunity to work together to find out how we can use information technology to improve patient care."

Cebul and Harris are working with several researchers at MetroHealth and the Clinic, plus faculty at the Case Weatherhead School of Management. Cebul said, "This project represents an unparalleled partnership in health care research among the School of Medicine, MetroHealth, The Cleveland Clinic and Weatherhead, which has the departments of information technology and economics involved."

The researchers will study about 200 primary care physicians in 12 practices in The Cleveland Clinic system and 10 in the MetroHealth system, and the13,000 patients with diabetes in those practices. The primary care practices and patients will be studied in four clusters.

In one cluster, physicians will use the EMR system with its current, standard format. The EMR system allows a doctor to access and view patients' medical records electronically through a computer.

A second cluster of physicians will use the EMR system enhanced with software that provides disease management guidelines and decision-support for physicians and other providers.

"The care of diabetes is very complex and a number of measures need to be monitored and measured to better take care of patients," said Cebul. "The decision-support within the EMR will allow physicians to view all of the important measures in all of their diabetic patients and, with a click of a button, update and order referrals, tests and treatments that need to be done for their patients. It consolidates all of the measures in the good process-of-care parameters that the American Diabetes Association and others have demonstrated are important in the care of patients with diabetes," he said.

A third cluster will use a Web-based patient empowerment program to give patients access to most of their own medical records on their home computers. On their Web portals, patients will be able to enter their daily sugar levels, and their doctors' offices can provide them with additional referrals or modifications to their insulin doses or their diabetes regimens. The Web portal modifies a commercially available system. It will be used in the practices at The Cleveland Clinic.

A fourth cluster of physicians will use both the enhanced EMR-based disease management system combined with the Web-portal program.

Cebul explained how care of patients with diabetes currently occurs and how this study is trying to move care to the next level. "Care in most places that do not have electronic medical records is a one-on-one interaction between the patient and the doctor," he said, "where the doctor is basically using his or her memory and best understanding of the literature to make decisions about testing and treatment. With the electronic medical record, there are opportunities for the providers to be given alerts when care is out of standard guidelines, and to assist the physicians in making care decisions for their patients.

"In this new approach, we've essentially created more active alerts and decision supports for providers, to let them comprehensively view all the measures in the care of patients with diabetes as well as view information about all of their diabetic patients and how they're doing. In addition, we're studying how the patients' involvement in care through the Web might enhance care and treatment."

Diabetes is an epidemic in Greater Cleveland and throughout the United States, said Cebul. About 200,000 people in Northeast Ohio have type 2 diabetes, and the number is expected to rise because the population is aging and the incidence of obesity is increasing. In the United States about 18 million people, or a little more than 6 percent of the population, has diabetes, with type 2 being the most prominent form of the disease. Diabetes is a risk factor for the nation's first (heart) and third (stroke) leading causes of death in the United States.

Case Western Reserve University

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