Medical records are finally catching up with the digital age. As of 2012, 69 percent of U.S. primary care physicians were using EHRs—a leap from 46 percent in 2009.
“When you think of health care, which is inherently information-intensive, you need ways to process it better, and computers can help,” says Ilana Graetz, an assistant professor at the University of Tennessee Health Science Center, who graduated from Berkeley’s Health Services and Policy Analysis (HSPA) doctoral program in 2012.
Before moving to Tennessee last fall, Graetz had worked for nine years as a research associate and data analyst at Kaiser Permanente Northern California, an early adopter of EHRs. Much of her research at Kaiser focused on use of EHRs and how it affects primary care teams.
Through her work at Kaiser, Graetz met Professors Stephen Shortell and Thomas Rundall, who introduced her to the HSPA program at Berkeley. When she entered the program, Graetz already knew that she wanted to continue working with Shortell and Rundall and focus on EHRs for her dissertation.
“It was nice having a project in mind and being able to think about how to apply the theories that I was learning to this question of how EHRs change care delivery,” she says. “I had a lot of data to play with going through all my statistics and study design classes.”
The data were collected using surveys sent to physicians, nurse practitioners, and physician’s assistants working at Kaiser during the organization’s implementation of EHRs. Clinicians using EHRs were asked about the availability and timeliness of relevant medical information; agreement among clinicians about treatment goals and each party’s roles and responsibilities; and their use of EHRs for eight specific clinical activities during their patient visits.
Drawing on these data, a study by Graetz and colleagues found a positive association between care coordination and use of EHRs: Clinicians who had been using EHRs for more than six months were more likely to report having timely access to relevant clinical information and agreement on roles and responsibilities.
For her dissertation, Graetz decided to examine how primary care team cohesion affects this association. She focused on coordination of care across delivery sites—for example, when a patient leaves the hospital for a primary care setting. Graetz found that teams that were already working well together showed a great improvement in care coordination with the EHR. However, teams that were not working together well saw no improvement at all.
“I really expected that that everyone would benefit from the EHR, and that maybe the teams that were working better would benefit more,” says Graetz. “It’s a bigger effect than what I anticipated.”
She speculates that although all of the clinicians in the study had the same formal training in use of the technology, members of less cohesive teams might have had less support from their professional networks in learning and navigating the new system and sharing best practices.
Recently, Graetz has been looking at EHR use and its association with clinical care processes and disease control in patients with diabetes. A study she coauthored found that EHR use was associated with improved drug treatment intensification, monitoring, and physiologic control among patients with diabetes. A more recent study, not yet published, looks at the effect of team cohesion on these patient outcomes.
Though her research shows that EHRs have the potential to increase the quality of care, Graetz keeps her expectations focused and realistic.
“People are very optimistic about all of the ways EHRs are going to fix the health care system,” she says, “but I tend to be a little bit more cautious about it, because it’s not a magic bullet. It’s not enough to just have it—you have to be using it in a way that’s helpful.”