Electronic health records with technical assistance can improve patient care in New York City
The relationship between a physician practice's adoption of electronic health records (EHR) and quality improvements in patient care remains unclear. However, a new study published in the January issue of Health Affairs by Weill Cornell Medical College and the Primary Care Information Project (PCIP) of the New York City Health Department shows evidence that EHR implementation can improve patient care in small physician practices in New York City when combined with sustained high-intensity technical assistance.
To evaluate the effects EHRs have on patient care within small physician practices, the research team used an independent data source using multi-payer medical claims in New York state (New York Quality Alliance), linking the data to small practices enrolled in the Primary Care Information Project. This New York City Health Department initiative provided subsidized EHR software with clinical decision support and onsite technical assistance to 3,300 physicians at 600 primary care practices in underserved neighborhoods serving disadvantaged populations to improve quality of care. This is the United States' largest community-based EHR implementation program, and the PCIP continues to provide technical assistance and education to more than 7,200 providers through its regional extension center, NYC REACH.
The research study found EHR implementation alone was not enough to improve patient care overall or known "EHR sensitive" quality improvement measures, such as cancer screenings and diabetes care. In fact, the researchers reported it took physician practices a minimum of nine months of EHR exposure, combined with eight or more technical assistance visits, to demonstrate any significant statistical improvements in certain key quality measures, including breast cancer screening, retinal exam and urine testing for diabetes patients, chlamydia screening for women and colorectal cancer screening. Physician offices with minimal or no technical support did not show any significant improvements, even when these practices had been using EHRs for up to two years.
"EHRs were once thought to be a cure-all for helping improve patient care, but there are implementation issues and the technology has a steep learning curve," says lead author Dr. Andrew M. Ryan, assistant professor of public health at Weill Cornell Medical College. "Our study shows EHRs can in fact be a tool for quality improvement, but not in isolation. Technical assistance must be at the heart of the EHR implementation process. Under resourced, small physician practices, especially those taking care of underserved populations; need help to effectively use EHR technology to improve patient quality of care."
"These study findings are consistent with observations from our field staff that small physician practices serving the disadvantaged areas of New York City need considerably more technical support to use EHRs to improve quality," says Sarah Shih, executive director of Health Care Quality Information and Program Evaluation at PCIP. "High-intensity technical support has helped improve the quality of care provided by small physician practices in some key quality measures after nine months. In addition, PCIP has made major strides in using EHRs to improve population health among other key quality indicators not measured by claims data. We have also observed improved quality trends for smoking cessation counseling, blood pressure control, cholesterol screening and treatment."
Researchers say it will be important to continue to evaluate the effectiveness of various levels of technical support provided by regional extension centers in improving health outcomes.
EHRs supply physicians with clinical decision support, tools to reduce medical errors, e-prescribing, test result displays, patient health registry information, population data management and improved communication with patients and other providers. The rate of EHR adoption for outpatient care is rising. Physician use of basic EHR systems has increased from 22 percent in 2009 to 35 percent in 2011. But small practices, which constitute the majority of practices in the U.S., have the lowest rate of EHR adoption. Some evidence suggests small practices, especially those in underserved communities like New York City, are less likely to use EHRs.
"EHRs hold a lot of hope and promise and the technology is taking health care a step in the right direction. Our study supports proof of concept that EHRs can improve outcomes, but widespread implementation of the technology and strong technical assistance is needed," says Dr. Ryan. "Our hope is the extension of EHRs with proper technical support will have a direct impact on population health."
The study findings are consistent with other research showing that EHRs alone do not consistently improve quality of care. This is one of the few studies to have evaluated the effect of EHRs implementation on the quality of care in a community outpatient setting focusing on physicians in small practices who serve primarily disadvantaged patients.
"Our study results stand in contrast to widespread perceptions that EHRs automatically improve quality of care. It shows that regional extension centers like NYC REACH have an important role to play in facilitating the use of EHRs to improve the quality of care patients receive—which is always our ultimate goal," says the study's senior author Dr. Lawrence P. Casalino, the Livingston Farrand Associate Professor of Public Health and chief of the Division of Outcomes and Effectiveness Research at Weill Cornell. In addition, Dr. Tara F. Bishop, assistant professor of public health and medicine at Weill Cornell, is a co-author of the study.
Journal reference:
Health Affairs
Provided by
Weill Cornell Medical College
-
Doctors who go digital provide higher quality healthcare
Oct 17, 2012 |
not rated yet |
0
-
Better together - The RN and the EHR
Jan 17, 2012 |
not rated yet |
0
-
Electronic health records shown to improve the quality of patient care
Oct 09, 2012 |
not rated yet |
0
-
Electronic health records may lower malpractice settlements
Nov 25, 2008 |
not rated yet |
0
-
Pediatrician adoption of EHR systems lagging behind
Nov 19, 2012 |
not rated yet |
0
-
Motion perception revisited: High Phi effect challenges established motion perception assumptions
Apr 23, 2013 |
3 / 5 (2) |
2
-
Anything you can do I can do better: Neuromolecular foundations of the superiority illusion (Update)
Apr 02, 2013 |
4.5 / 5 (11) |
5
-
The visual system as economist: Neural resource allocation in visual adaptation
Mar 30, 2013 |
5 / 5 (2) |
9
-
Separate lives: Neuronal and organismal lifespans decoupled
Mar 27, 2013 |
4.9 / 5 (8) |
0
-
Sizing things up: The evolutionary neurobiology of scale invariance
Feb 28, 2013 |
4.8 / 5 (10) |
14
-
Classical and Quantum Mechanics via Lie algebras
Apr 15, 2011
- More from Physics Forums - Independent Research
More news stories
Survey reveals the success of personal budgets in social care
Over 70 per cent of people who hold a personal budget for social care said it led to greater independence and support according to the latest survey.
Health
1 hour ago |
not rated yet |
0
Scientists develop smartphone 'assistance agent' for older people
A new smartphone application, developed by scientists at the University of Ulster, which could help older people engage fully in an increasingly self-serve society, may be ready for use by the end of the ...
Health
2 hours ago |
not rated yet |
0
Can you put a price on health?
As health services strive to improve quality and reduce costs, researchers study the benefits – and the pitfalls – of 'pay for performance' in hospitals.
Health
2 hours ago |
not rated yet |
0
|
Air travel during pregnancy poses no significant risk, say experts
(Medical Xpress)—There is no significant risk directly associated with air travel during pregnancy, even at advanced gestation, says report by the University of Liverpool.
Health
2 hours ago |
not rated yet |
0
50 percent of Australians who oppose vaccination get their information from the Internet
To coincide with the broadcast of Jabbed: Love, Fear and Vaccines (SBS ONE, Sunday 26 May at 8.30pm) the first ever national survey on Australian attitudes to vaccination reveals surprising statistics including half of Australians ...
Health
2 hours ago |
not rated yet |
0
New discovery in fight against deadly meningococcal disease
Professor Michael Jennings, Deputy Director of the Institute for Glycomics at Griffith University, was part of an international team that discovered the previously unknown pathway of how the bacterium colonizes people.
Pay attention: How we focus and concentrate
Scientists at Newcastle University have shed new light on how the brain tunes in to relevant information.
New imaging techniques used to help patients suffering from epilepsy
New techniques in imaging of brain activity developed by Jean Gotman, from McGill University's Montreal Neurological Institute, and his colleagues lead to improved treatment of patients suffering from epilepsy. The combination ...
Researchers identify networks of neurons in the brain that are disrupted in psychiatric disease
Studying the networks of connections in the brains of people affected by schizophrenia, bipolar disease or depression has allowed Dr. Peter Williamson, from Western University, to gain a better understanding of the biological ...
Are kids who take music lessons different from other kids?
(Medical Xpress)—Research by U of T Mississauga psychology professor Glenn Schellenberg reveals that two key personality traits – openness-to-experience and conscientiousness—predict better than IQ ...
Study reveals active site of enzyme linked to stuttering
(Medical Xpress)—Scientists from the Joint Center for Structural Genomics (JCSG) at SLAC National Accelerator Laboratory have determined the 3-D structure of the chemically active part of an enzyme involved ...