Electronic medical records have low impact on quality of osteoporosis care
MedWire News: The use of electronic medical records (EMR) only marginally improves the care of patients with osteoporosis, a US pilot study has found.
The scheme, which was developed in collaboration with physicians and patients, resulted in a small increase in the use of calcium supplements but failed to increase diagnosis or treatment for osteoporosis in patients who had suffered a fragility fracture.
"Our findings highlight physician-related barriers to medical care of osteoporosis," say Beatrice Edwards (Northwestern University, Chicago, Illinois) and co-authors writing in Osteoporosis International.
Edwards and team harnessed the theoretical framework of the "chronic care model" to develop and implement an EMR system at Northwestern Memorial Hospital, a tertiary care hospital in Chicago.
They held focus groups with patients and physicians, created a multidisciplinary team to oversee the scheme, and developed an electronic "fracture/osteoporosis order set" that contained patient-centered, evidence-based recommendations for improving the management of osteoporosis.
Specific components of the "order set" included information on the diagnosis and evaluation of osteoporosis, a physician resource list with links to clinical guidelines, and patient education material.
Edwards et al studied the impact of the scheme by assessing quality indicators in July 2008 (pre-implementation) and again in April 2009 (post-implementation). During this time, 295 patients aged 50 years and over were admitted with a fracture.
The mean age of the patients was 72 years and three-quarters were female. The sites of fracture were hip (27%), vertebrae (30%), lower extremity (21%), upper extremity (15%), and pelvis (9%).
Following implementation of the EMR intervention, there was a "modest" improvement in clinical care, say the authors, with a trend towards greater calcium supplementation.
However, the proportion of patients who were diagnosed with osteoporosis, prescribed antiresorptive drugs, or referred for bone mineral density testing remained low, at below 15% for each indicator.
Edwards et al conclude: "An EMR intervention developed with physician input, yet without physician reminders, had a modest effect on increasing evaluation or treatment for osteoporosis over the following months.
"It would appear that competing demands for the clinicians' time, confusion over radiographic reporting and 'nonacute nature of osteoporosis' would play a role in the lack of attention to osteoporosis care."
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By Joanna Lyford