Providers w/ EHRs order more mammograms

Women who receive healthcare from providers equipped with an EHR may be more likely to be referred for a mammogram and other preventive health services, and the link may be stronger with more sophisticated EHR systems, according to a study published in the February issue of the Journal of the American Medical Informatics Association.   

Although the potential for EHRs to improve preventive care has been touted, the link between system sophistication and preventive patient care remains unclear.

Namita L. Tundia, doctoral candidate at the University of Cincinnati, and colleagues leveraged the National Ambulatory Medical Care Survey database for the years 2007 and 2008 to evaluate the relationship between the level of EHR sophistication and 11 preventive healthcare services for women.

Based on providers’ answers to questions relating to 16 features,  the researchers categorized EHR sophistication as: no system, minimal, basic or fully functional. To be defined as fully functional, a system had to provide four basic functions (patient demographics, lab results, imaging results and clinical notes) and at least 10 additional functions, such as orders for prescriptions and orders for tests.

The preventive health services studied were the number of:

• breast exams ordered or provided;
• pelvic exams ordered or provided;
• Pap tests ordered or provided;
• chlamydia tests ordered or provided;
• cholesterol tests ordered or provided;
• blood pressure tests ordered or provided;
• mammograms ordered or provided;
• bone mineral density tests ordered or provided;
• flu vaccinations ordered or provided;
• visits including education on nutrition and diet; and
• visits including education on exercise.

In 2007-08, 29.23 percent of providers had no EHR, 49.34 percent had a minimal system, 15.97 had a basic system and 5.46 had a fully functional system.

Tundia and colleagues observed a relationship between system sophistication and the rate at which certain preventive measures were ordered or provided.

Approximately 10.5 percent of women ages 40 or older whose visits were to providers with no EHR were provided or ordered a mammogram. For minimal, basic and fully functional systems the mammogram rates were 23.2 percent, 15.2 percent and 29.4 percent, respectively. “For all women’s health measures, except for chlamydia testing and the seasonal flu vaccination, providers with no EHR systems had the lowest rates,” wrote Tundia and colleagues.

The researchers found solo practices, relative to group practices, were less likely to have basic and fully functional systems and more likely to have no system in place. They noted that incidence rate ratios for mammograms fell with the level of system sophistication, declining from 1.28 for minimal systems to 1.26 for basic systems and 1.20 for fully functional systems.

Demographic information available in minimal systems may be important for ordering mammograms; however, higher level functions such as electronic reminders may not be as critical for mammograms and other exams characterized by low cost and high awareness, according to Tundia et al.

Limitations of the study included the inability to determine if ordered tests were provided. The researchers also acknowledged the “fast-paced development and adoption of EMR system technology,” which will date these results quickly.

Finally, Tundia et al suggested directions for future studies, such as identifying which advanced functions are more important for women’s health.