The Bettering Lives Utilizing Electronic Systems (BLUES) Project: Improving Diabetes Outcomes in Mississippi with Health Information Technology

The Delta Health Alliance and the University of Mississippi Medical Center (UMMC) collaborated on the Bettering Lives Utilizing Electronic Systems (BLUES) Project to evaluate whether the use of an electronic health record (EHR) in the management of diabetes would enhance health care delivery and lead to improved outcomes in patients. Specifically the study team looked at the ability of EHRs to facilitate patient outcomes tracking, improve provider communication, reduce medical errors, and improve quality of care. Four diabetes management clinics, all using the same model for diabetes care, participated in this study. Two of the clinics were in urban settings and two were in rural settings. One clinic in each setting used an EHR, allowing the project team to compare the health outcomes of patients with and without the use of technology. There were three outcomes of interest: hemoglobin A1c (HbA1c), low density lipoprotein (LDL), and blood pressure. Both quantitative and qualitative methods were used in the study.

The main objectives of this project were to:

• Implement an EHR system in two existing diabetes management clinics, focusing on integration of the EHR into clinician workflows.
• Evaluate the impact of the EHR system on clinical processes of care and patient outcomes.
• Produce and distribute a generalizable, replicable model of care for implementing an integrated health information technology (IT) system for diabetes management care throughout the United States.

Findings from the EHR versus non-EHR sites were mixed. The LDL results improved at the EHR sites, indicating a positive effect of the EHR. Substantially lower levels of LDL were seen at follow-up versus baseline in both the urban and rural EHR clinics, and slight increases in LDL were seen in both the urban and rural non-technology clinics. Regarding HbA1C levels, there were small increases from baseline to follow-up, with the exception of a decrease in HbA1c levels seen in the rural non-EHR clinic. Changes in the percent of patients with an average HbA1c level below nine were small. Lastly, changes in blood pressures were minor with the exception of a sizable increase in the percent with low overall blood pressure in the rural non-EHR clinic, and a very large drop in the percent of patients with low overall blood pressure in the rural EHR clinic.

The project team concluded that the use of EHRs in and of themselves does not improve health care in diabetics. However, these findings can be used to imply that best practices for disease management and care coordination in conjunction with the implementation of health IT do improve health outcomes for patients. EHRs combined with adequate training and tools result in improved process of care measures, such as timely and appropriate exams and lab testing; greater patient satisfaction; enhanced diabetes-related outcomes; improved provider satisfaction; better medication management; increased patient safety; and reduced costs related to care.