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Electronic Health Records and Ambulatory Quality of Care

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The US Federal Government is investing up to $29 billion in incentives for meaningful use of electronic health records (EHRs). However, the effect of EHRs on ambulatory quality is unclear, with several large studies finding no effect.


To determine the effect of EHRs on ambulatory quality in a community-based setting.


Cross-sectional study, using data from 2008.


Ambulatory practices in the Hudson Valley of New York, with a median practice size of four physicians.


We included all general internists, pediatricians and family medicine physicians who: were members of the Taconic Independent Practice Association, had patients in a data set of claims aggregated across five health plans, and had at least 30 patients per measure for at least one of nine quality measures selected by the health plans.


Adoption of an EHR.


We compared physicians using EHRs to physicians using paper on performance for each of the nine quality measures, using t-tests. We also created a composite quality score by standardizing performance against a national benchmark and averaging standardized performance across measures. We used generalized estimation equations, adjusting for nine physician characteristics.


We included 466 physicians and 74,618 unique patients. Of the physicians, 204 (44 %) had adopted EHRs and 262 (56 %) were using paper. Electronic health record use was associated with significantly higher quality of care for four of the measures: hemoglobin A1c testing in diabetes, breast cancer screening, chlamydia screening, and colorectal cancer screening. Effect sizes ranged from 3 to 13 percentage points per measure. When all nine measures were combined into a composite, EHR use was associated with higher quality of care (sd 0.4, p = 0.008).


This is one of the first studies to find a positive association between EHRs and ambulatory quality in a community-based setting.

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This work was supported by the Commonwealth Fund, the Taconic Independent Practice Association, and the New York State Department of Health (contract #C023699). The authors specifically thank A. John Blair III, MD, President of the Taconic IPA and CEO of MedAllies, and Susan Stuard, MBA, Executive Director of THINC. All authors have contributed sufficiently to be authors and have approved the final manuscript. The authors take full responsibility for the design and conduct of the study and controlled the decision to publish. The authors had full access to the data, and take responsibility for the integrity of the data and the accuracy of the data analysis. A full list of HITEC Investigators can be found at: This work was previously presented as a poster at the Annual Symposium of the American Medical Informatics Association on October 25, 2011.

Conflict of Interest

The authors declare that they do not have conflicts of interest.

Role of the Funding Agencies

The funding sources had no role in the study’s design, conduct or reporting.

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Correspondence to Lisa M. Kern MD, MPH.



Figure 2.
figure 2

Logic for attributing patients to primary care physicians. *See Figure 1 for a derivation of the study sample.

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Kern, L.M., Barrón, Y., Dhopeshwarkar, R.V. et al. Electronic Health Records and Ambulatory Quality of Care. J GEN INTERN MED 28, 496–503 (2013).

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