Effectiveness of the electronic medical record in improving the management of hypertension.

Clinical studies suggest that hypertension is often undiagnosed, undertreated, and poorly controlled. In 1997, the authors developed a comprehensive electronic medical record that interfaces with physicians during each outpatient visit and provides real-time feedback about patient care management, including the management of hypertension. The purpose of this study was to determine whether this interactive electronic medical record results in better detection and control of hypertension. During a 12-month study period, consecutive outpatients (n=1076) were seen for routine follow-up; patient care documentation relied solely on the electronic medical record. Quality indicators for hypertension included: 1) documentation of the diagnosis of hypertension; 2) use of blood pressure-lowering drugs; and 3) successful blood pressure lowering to < or =140/90 mm Hg. The authors compared the hypertension management of these patients to a control group of similar patients (n=723) with medical records consisting solely of traditional pen and paper charts. Baseline characteristics were similar between the two groups, including the prevalence of hypertension (73% vs. 70%; p=NS). However, the electronic medical record resulted in higher documentation rates of hypertension (90% vs. 77%; p<0.001), greater use of antihypertensive therapy (94% vs. 90%; p<0.01), and more successful blood pressure lowering to < or =140/90 mm Hg (54% vs. 28%; p<0.001). In conclusion, the electronic medical record with real-time feedback improves the physicians ability to detect, treat, and control hypertension.

Cardiovascular risk management in clinical practice: the Midwest Heart Specialists experience.

Evaluating cardiovascular risk and managing hypercholesterolemia are essential components in the identification and treatment of coronary artery disease. A collaborative care-based lipid clinic is a beneficial part of an integrated prevention program and can result in improved lipid management. Advances in technology now enable use of the electronic medical record in combination with a virtual lipid clinic to promote superior cholesterol management.