Diabetes Prevention, Health Information Technology, and Meaningful Use

Challenges and Opportunities
  • Faraz S. Ahmad
    Address correspondence to: Faraz S. Ahmad, MD, Hospital of the University of Pennsylvania, 3400 Spruce St., 100 Centrex, Philadelphia PA 19104
    Center for Healthcare Improvement and Patient Safety, the Center for Therapeutic Effectiveness Research, the Philadelphia VA Medical Center, Philadelphia, Pennsylvania

    Perelman School of Medicine, University of Pennsylvania, the Philadelphia VA Medical Center, Philadelphia, Pennsylvania
    Search for articles by this author
  • Thomas Tsang
    Strategy and Business Development, Health Information Partnerships, Merck Pharmaceuticals, Boston, Massachusetts
    Search for articles by this author


      The U.S. health system has historically been poorly equipped to confront the growing impact of diabetes on the nation's health. The Affordable Care Act legislates a number of new strategies—such as innovative payment and delivery models and increased public health funding—intended to improve diabetes prevention and care quality. Health information technology (IT) is often cited as a critical part of these strategies. Through the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009, the federal government has been supporting the rapid adoption of health IT, and more specifically of electronic health records (EHRs) through the Centers for Medicare and Medicaid Services (CMS) EHR Incentive Program. Health IT has the potential to contribute to diabetes prevention and improved quality of care, but the evidence supporting its benefits is mixed. This article provides a brief overview of the CMS EHR Incentive Program and meaningful-use criteria. Then it examines health IT strategies for diabetes prevention in the context of current evidence and identifies areas of needed research and innovation.
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        • CDC
        Diabetes report card 2012.
        CDC, DHHS, Atlanta GA2012
        • Thorpe K.E.
        The Affordable Care Act lays the groundwork for a national diabetes prevention and treatment strategy.
        Health Aff. 2012; 31: 61-66
        • Bates D.W.
        • Bitton A.
        The future of health information technology in the patient-centered medical home.
        Health Aff (Millwood). 2010; 29: 614-621
        • Bitton A.
        • Flier L.A.
        • Jha A.K.
        Health information technology in the era of care delivery reform: to what end?.
        JAMA. 2012; 307: 2593-2594
        • Leventhal T.
        • Taliaferro J.P.
        • Wong K.
        • Hughes C.
        • Mun S.
        The patient-centered medical home and health information technology.
        Telemed J E Health. 2012; 18: 145-149
        • Linder J.A.
        • Ma J.
        • Bates D.W.
        • Middleton B.
        • Stafford R.S.
        Electronic health record use and the quality of ambulatory care in the U.S.
        Arch Intern Med. 2007; 167: 1400-1405
        • Walsh M.N.
        • Yancy C.W.
        • Albert N.M.
        • et al.
        Electronic health records and quality of care for heart failure.
        Am Heart J. 2010; 159: 635-642.e1
        • Walsh M.N.
        • Albert N.M.
        • Curtis A.B.
        • et al.
        Lack of association between electronic health record systems and improvement in use of evidence-based heart failure therapies in outpatient cardiology practices.
        Clin Cardiol. 2012; 35: 187-196
        • McCormick D.
        • Bor D.H.
        • Woolhandler S.
        • Himmelstein D.U.
        Giving office-based physicians electronic access to patients' prior imaging and lab results did not deter ordering of tests.
        Health Aff (Millwood). 2012; 31: 488-496
        • Koppel R.
        • Metlay J.P.
        • Cohen A.
        • et al.
        Role of computerized physician order entry systems in facilitating medication errors.
        JAMA. 2005; 293: 1197-1203
        • Ash J.S.
        Some unintended consequences of information technology in health care: the nature of patient care information system-related errors.
        JAMA. 2003; 11: 104-112
        • Himmelstein D.U.
        • Wright A.
        • Woolhandler S.
        Hospital computing and the costs and quality of care: a national study.
        JAMA. 2010; 123: 40-46
        • Zhou L.
        • Soran C.S.
        • Jenter C.A.
        • et al.
        The relationship between electronic health record use and quality of care over time.
        JAMA. 2009; 16: 457-464
        • Bates D.W.
        • Leape L.L.
        • Cullen D.J.
        • et al.
        Effect of computerized physician order entry and a team intervention on prevention of serious medication errors.
        JAMA. 1998; 280: 1311-1316
        • Chaudhry B.
        • Wang J.
        • Wu S.
        • et al.
        Systematic review: impact of health information technology on quality, efficiency, and costs of medical care.
        Ann Intern Med. 2006; 144: 742-752
        • Kaushal R.
        • Shojania K.G.
        • Bates D.W.
        Effects of computerized physician order entry and clinical decision support systems on medication safety: a systematic review.
        Arch Intern Med. 2003; 163: 1409-1416
        • DesRoches C.M.
        • Campbell E.G.
        • Vogeli C.
        • et al.
        Electronic health records' limited successes suggest more targeted uses.
        Health Aff. 2010; 29: 639-646
        • Buntin M.B.
        • Burke M.F.
        • Hoaglin M.C.
        • Blumenthal D.
        The benefits of health information technology: a review of the recent literature shows predominantly positive results.
        Health Aff. 2011; 30: 464-471
        • Goldzweig C.L.
        • Towfigh A.
        • Maglione M.
        • Shekelle P.G.
        Costs and benefits of health information technology: new trends from the literature.
        Health Aff (Millwood). 2009; 28: w282-w293
        • Blumenthal D.
        Stimulating the adoption of health information technology.
        N Engl J Med. 2009; 360: 1477-1479
        • Blumenthal D.
        Launching HITECH.
        N Engl J Med. 2010; 362: 382-385
        • Bipartisan Policy Center Task Force on Delivery System Reform and Health IT
        Transforming health care: the role of health IT.
        Bipartisan Policy Cente. 2012; : 1-48
        • Centers for Medicare and Medicaid Services
        Medicare and Medicaid Programs; Electronic Health Record Incentive Program—Stage 2.
        Federal Register. 2012;
        • Marcotte L.
        • Seidman J.
        • Trudel K.
        • et al.
        Achieving meaningful use of health information technology: a guide for physicians to the EHR incentive programs achieving meaningful use of health IT.
        Arch Intern Med. 2012; 172: 731-736
        • Centers for Medicare & Medicaid Services
        Medicare & Medicaid EHR incentive program: meaningful use Stage 1 requirements summary. 2010; : 1-23
        • Cebul R.D.
        • Love T.E.
        • Jain A.K.
        • Hebert C.J.
        Electronic health records and quality of diabetes care.
        N Engl J Med. 2011; 365: 825-833
        • Crosson J.C.
        • Ohman-Strickland P.A.
        • Cohen D.J.
        • Clark E.C.
        • Crabtree B.F.
        Typical electronic health record use in primary care practices and the quality of diabetes care.
        Ann Fam Med. 2012; 10: 221-227
        • Reed M.
        • Huang J.
        • Graetz I.
        • et al.
        Outpatient electronic health records and the clinical care and outcomes of patients with diabetes mellitus.
        Ann Intern Med. 2012; 157: 482-489
        • Bowens F.M.
        • Frye P.A.
        • Jones W.A.
        Health information technology: integration of clinical workflow into meaningful use of electronic health records.
        Perspect Health Inf Manag. 2010; 7: 1d
        • Crosson J.C.
        • Ohman-Strickland P.A.
        • Hahn K.A.
        • et al.
        Electronic medical records and diabetes quality of care: results from a sample of family medicine practices.
        Ann Fam Med. 2007; 5: 209-215
        • Costa B.M.
        • Fitzgerald K.J.
        • Jones K.M.
        • Dunning Am T.
        Effectiveness of IT-based diabetes management interventions: a review of the literature.
        BMC Fam Pract. 2009; 10: 72
        • Mohammed K Ali S.S.N.T.
        Databases for diabetes epidemiology: review of electronic decision-support tools for diabetes care: a viable option for low- and middle-income countries?.
        J Diabetes Sci Technol. 2011; 5: 553-570
        • Meigs J.B.
        • Cagliero E.
        • Dubey A.
        • et al.
        A controlled trial of web-based diabetes disease management: the MGH diabetes primary care improvement project.
        Diabetes Care. 2003; 26: 750-757
        • Montori V.M.
        • Dinneen S.F.
        • Gorman C.A.
        • et al.
        The impact of planned care and a diabetes electronic management system on community-based diabetes care: the Mayo Health System Diabetes Translation Project.
        Diabetes Care. 2002; 25: 1952-1957
        • O'Connor P.J.
        • Sperl-Hillen J.M.
        • Rush W.A.
        • et al.
        Impact of electronic health record clinical decision support on diabetes care: a randomized trial.
        Ann Fam Med. 2011; 9: 12-21
        • Holbrook A.
        • Thabane L.
        • Keshavjee K.
        • et al.
        Individualized electronic decision support and reminders to improve diabetes care in the community: COMPETE II randomized trial.
        Can Med Assoc J. 2009; 181: 37-44
        • Berikai P.
        • Meyer P.M.
        • Kazlauskaite R.
        • Savoy B.
        • Kozik K.
        • Fogelfeld L.
        Gain in patients' knowledge of diabetes management targets is associated with better glycemic control.
        Diabetes Care. 2007; 30: 1587-1589
        • Holtz B.
        • Lauckner C.
        Diabetes management via mobile phones: a systematic review.
        Telemed J E Health. 2012; 18: 175-184
        • Chomutare T.
        • Fernandez-Luque L.
        • Arsand E.
        • Hartvigsen G.
        Features of mobile diabetes applications: review of the literature and analysis of current applications compared against evidence-based guidelines.
        J Med Internet Res. 2011; 13: e65
        • Grant R.W.
        • Wald J.S.
        • Schnipper J.L.
        • et al.
        Practice-linked online personal health records for type 2 diabetes mellitus: a randomized controlled trial.
        Arch Intern Med. 2008; 168: 1776-1782
        • Balas E.A.
        • Krishna S.
        • Kretschmer R.A.
        • Cheek T.R.
        • Lobach D.F.
        • Boren S.A.
        Computerized knowledge management in diabetes care.
        Med Care. 2004; 42: 610-621
        • Quinn C.C.
        • Clough S.S.
        • Minor J.M.
        • Lender D.
        • Okafor M.C.
        • Gruber-Baldini A.
        WellDoc™ mobile diabetes management randomized controlled trial: change in clinical and behavioral outcomes and patient and physician satisfaction.
        Diabetes Technol Ther. 2008; 10: 160-168
        • Jimison H.
        • Gorman P.
        • Woods S.
        • et al.
        Barriers and drivers of health information technology use for the elderly, chronically III, and underserved.
        Evidence Reports/Technology Assessments, Rockville MD2008
        • DHHS
        National strategy for quality improvement in health care.
        ( 2011)
        • Hussain A.
        • Claussen B.
        • Ramachandran A.
        • Williams R.
        Prevention of type 2 diabetes: a review.
        Diabetes Res Clin Pract. 2007; 76: 317-326
        • Ogden C.L.
        • Carroll M.D.
        • Kit B.K.
        • Flegal K.M.
        Prevalence of obesity in the U.S., 2009–2010.
        NCHS Data Brief. 2012; 82: 1-8
        • Diabetes Prevention Program Research Group
        Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin.
        N Engl J Med. 2002; 346: 393-403
        • Diabetes Prevention Program Research Group
        10-year follow-up of diabetes incidence and weight loss in the Diabetes Prevention Program Outcomes Study.
        Lancet. 2009; 374: 1677-1686
        • Krumholz H.M.
        • Radford M.J.
        • Wang Y.
        • Chen J.
        • Heiat A.
        • Marciniak T.A.
        National use and effectiveness of beta-blockers for the treatment of elderly patients after acute myocardial infarction: National Cooperative Cardiovascular Project.
        JAMA. 1998; 280: 623-629
        • Lee T.H.
        Eulogy for a quality measure.
        N Engl J Med. 2007; 357: 1175-1177
        • Parsons A.
        • McCullough C.
        • Wang J.
        • Shih S.
        Validity of electronic health record-derived quality measurement for performance monitoring.
        J Am Med Inform Assoc. 2012; 19: 604-609
        • Chan K.S.
        • Fowles J.B.
        • Weiner J.P.
        Review: electronic health records and the reliability and validity of quality measures: a review of the literature.
        Med Care Res Rev. 2010; 67: 503-527
        • Weiner J.P.
        • Fowles J.B.
        • Chan K.S.
        New paradigms for measuring clinical performance using electronic health records.
        Int J Qual Health Care. 2012; 24: 200-205
        • Lenert L.
        • Sundwall D.N.
        Public health surveillance and meaningful use regulations: a crisis of opportunity.
        Am J Public Health. 2012; 102: e1-e7
        • Hsiao C.-J.
        • Hing E.
        • Socey T.C.
        • Cai B.
        Electronic health record systems and intent to apply for meaningful use incentives among office-based physician practices: U.S., 2001–2011.
        NCHS Data Brief. 2011; 79: 1-8
        • Jamoom E.
        • Beatty P.
        • Bercovitz A.
        • Woodwell D.
        • Palso K.
        • Rechtsteiner E.
        Physician adoption of electronic health record systems: U.S., 2011.
        National Center for Health Statistics, Hyattesville MD2012
        • Free C.
        • Knight R.
        • Robertson S.
        • et al.
        Smoking cessation support delivered via mobile phone text messaging (txt2stop): a single-blind, randomised trial.
        Lancet. 2011; 378: 49-55
        • American Diabetes Association
        American Diabetes Association advising on the use of information technology to improve diabetes prevention, Management in Beacon Communities.
        ( 2011)
        • Rein A.
        • Kennedy H.
        • DeCoudres B.
        • Cohen R.S.
        • Sabharwal R.
        • Fairbrother G.
        Evaluation design and technical assistance opportunities: early findings from the Beacon Community Program evaluation teams.
        Issue Brief (Commonw Fund). 2012; 1: 1-22
        • Asch D.A.
        • Muller R.W.
        • Volpp K.G.
        Automated hovering in health care—watching over the 5000 hours.
        N Engl J Med. 2012; 367: 1-3
        • Long J.A.
        • Jahnle E.C.
        • Richardson D.M.
        • Loewenstein G.
        • Volpp K.G.
        Peer mentoring and financial incentives to improve glucose control in African American veterans: a randomized trial.
        Ann Intern Med. 2012; 156: 416-424
        • Baig A.A.
        • Wilkes A.E.
        • Davis A.M.
        • et al.
        The use of quality improvement and health information technology approaches to improve diabetes outcomes in African American and Hispanic patients.
        Med Care Res Rev. 2010; 67: 163S-197S