Electronic Thesis and Dissertation Repository


Master of Clinical Science


Family Medicine


Moria Stewart

2nd Supervisor

Marshall Godwin


PURPOSE This study was designed to determine whether the use of advanced features of an electronic medical record in a primary care setting could improve the process of delivering diabetes care in such a way as to produce improvements in diabetic outcome measures in adult type II diabetic patients.

METHODS The study was a Retrospective Cohort Study conducted in primary care clinics that had an established electronic medical record following 307 adult patients with type II diabetes over the course of two years. The clinics had similarly trained primary care

physicians, similar patient populations, and used common diabetic care guidelines. The advanced EMR features used during the diabetic study included a diabetic template, premade laboratory requisitions, appeared consultations, flow sheets, and patient alerts.

The dependent variables measured included the process of the delivery of diabetic care and the measurement of diabetic outcomes. The process of care measures were: the frequency of visits specific for diabetes care, ordering of HbA1c and LDL cholesterol, the measurement of blood pressure, and the documentation of these activities. The outcome

measures included glycemic, lipid and blood pressure control as measured by HbA1c, LDL and blood pressure levels. The two independent variables of interest in the study were the extent to which the advanced features EMR are use by the physician and the second any changes noted in the outcome measures.

RESULTS The demographic information for the patients in this study was sex and age as well as baseline HbA1c, LDL, baseline systolic blood pressures, baseline diastolic blood pressures, and the number of visits that each patient had during the study period. The two groups were seen to be similar at baseline except for age and systolic blood pressure. The mean age of the intervention group was four years older than the control group and the comparison group had more people with systolic blood pressure at target. Age and systolic blood pressure were therefore controlled in the analysis. There was no difference in the two groups of patients in terms of measurements of HbA1c but there were differences in the frequency of measurements of LDL and blood pressures. Patients for whom the template was used during at least one clinical encounter, were 1.18 times more likely to have their LDL measured and 1.9 times more likely to have their blood pressure measured.

Using logistics regression analysis there was a higher proportion of patients with an LDL at target in the intervention group.

CONCLUSIONS The meaningful use of EMRs in primary care, is possible through a process of maturity by design; an individualized approach looking at the needs of a given physician(s) and their practice(s) most likely to aid EMRs in achieving their potential. The

technology needs to support care by automation of clinical processes and work flow behind the computer screen in such a way as to not disrupt or significantly change the patient physician interaction and focus both of these individuals on managing meaningful clinical outcomes personalized to each patient.