Financial Incentives, Quality Improvement Programs, and the Adoption of Clinical Information Technology

University of California, School of Public Health, Berkeley, California 94720-7360, USA.
Medical care (Impact Factor: 3.23). 03/2009; 47(4):411-7. DOI: 10.1097/MLR.0b013e31818d7746
Source: PubMed


Physician use of clinical information technology (CIT) is important for the management of chronic illness, but has lagged behind expectations. We studied the role of health insurers' financial incentives (including pay-for-performance) and quality improvement initiatives in accelerating adoption of CIT in large physician practices.
National survey of all medical groups and independent practice association (IPA) physician organizations with 20 or more physicians in the United States in 2006 to 2007. The response rate was 60.3%. Use of 19 CIT capabilities was measured. Multivariate statistical analysis of financial and organizational factors associated with adoption and use of CIT.
Use of information technology varied across physician organizations, including electronic access to laboratory test results (medical groups, 49.3%; IPAs, 19.6%), alerts for potential drug interactions (medical groups, 33.9%; IPAs, 9.5%), electronic drug prescribing (medical groups, 41.9%; IPAs, 25.1%), and physician use of e-mail with patients (medical groups, 34.2%; IPAs, 29.1%). Adoption of CIT was stronger for physician organizations evaluated by external entities for pay-for-performance and public reporting purposes (P = 0.042) and for those participating in quality improvement initiatives (P < 0.001).
External incentives and participation in quality improvement initiatives are associated with greater use of CIT by large physician practices.


Available from: James C Robinson, Oct 10, 2014
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    • "Patients that are re-admitted to a hospital within thirty days of discharge for the same ailment will trigger a 'claw-back' where Medicare seeks to recover its earlier payment. Such changes to payment schemes are important new external influences that may also affect HIT innovation and adoption rates [41]. There are three main rationales for studying EHR adoption. "
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    • "Other benefits leading to a more systematic approach to disease management include contact with other clinicians regarding patient care (Qavi et al., 2001; Baldwin et al., 2002); elimination of redundancy in patient care (Pelletier-Fleury et al., 1999); enhancements to the effectiveness of the practice (Andersson et al., 2002) and improvement to laboratory information systems (Harrison & McDowell, 2008; Robinson et al., 2009). Other medical drivers for ICT adoption that have been examined in the literature include the ability to keep in touch with medical and other developments (Agrawal et al., 2007; Gagnon et al., 2009; Lucas, 2008); the ability to generate prescriptions and includes checking drug interactions (Papazafeiropoulou & Gandecha, 2007; Robinson et al., 2009; Chon et al., 2008) and to keep in contact with hospitals, nursing homes, etc (Husk & Waxman, 2004; Harrison & McDowell, 2008). As already noted, the use of ICT in medical and healthcare facilities not only enhances patient treatment but assists the practice in normal business activities. "
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