Massachusetts E-Health Project Increased Physicians' Ability To Use Registries, And Signals Progress Toward Better Care

Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, and Brigham and Women's Hospital, Boston, MA, USA.
Health Affairs (Impact Factor: 4.97). 07/2011; 30(7):1256-64. DOI: 10.1377/hlthaff.2010.1020
Source: PubMed


The ability to generate and use registries--lists of patients with specific conditions, medications, or test results--is considered a measure of physicians' engagement with electronic health record systems and a proxy for high-quality health care. We conducted a pre-post survey of registry capability among physicians participating in the Massachusetts eHealth Collaborative, a four-year, $50 million health information technology program. Physicians who participated in the program increased their ability to generate some types of registries--specifically, for laboratory results and medication use. Our analysis also suggested that physicians who used their electronic health records more intensively were more likely to use registries, particularly in caring for patients with diabetes, compared to physicians reporting less avid use of electronic health records. This statewide project may be a viable model for regional efforts to expand health information technology and improve the quality of care.

    • "The ability to exchange electronic patient data – health information exchange (HIE) – is anticipated to help improve the quality and safety of medical care by improving clinicians' access to comprehensive patient data and is often accomplished via interoperable electronic health record systems (EHRs). Various national and state-level initiatives are working to provide clinicians with HIE services such as web-based portals, data delivery to interoperable EHRs, and clinical document exchange between EHRs (Yasnoff et al. 2004; Stead, Kelly, and Kolodner 2005; The Direct Project 2012; Fleurant et al. 2011). Traditionally, interoperability has been defined and described from a techno-centric "
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    ABSTRACT: Successful design and implementation of interoperable health IT requires an understanding of specific technological capabilities of systems, as well as how these systems impact clinical workflow. Several existing frameworks classify interoperability levels, but none focus on the impact on clinical work, particularly at the task level. A synthesis of existing interoperability frameworks from select interoperability frameworks in the literature about both medical and non-medical systems is presented and a new, 7-level framework in order to characterise the effect of varying levels of interoperability on the users’ work based upon qualitative data collected in a field study of the use of health information exchange in 12 ambulatory practices is proposed. The lowest level describes paper-based tasks completed with no access to electronic information from other institutions; the highest level describes interoperable systems in which data elements from other institutions are integrated into the patient's record seamlessly and in a computable format.
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    • "There is also a need for further examination of factors that may facilitate the progressive effect of HIT. As reported by recent studies, [39] a further understanding of how physicians engage with information technology systems, as well as the efficient and effective use of information generated from electronic systems at the point of care and beyond, is essential to optimizing the benefits of HIT. "
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    ABSTRACT: Background The adoption of health information technology has been recommended as a viable mechanism for improving quality of care and patient health outcomes. However, the capacity of health information technology (i.e., availability and use of multiple and advanced functionalities), particularly in federally qualified health centers (FQHCs) on improving quality of care is not well understood. We examined associations between health information technology (HIT) capacity at FQHCs and quality of care, measured by the receipt of discharge summary, frequency of patients receiving reminders/notifications for preventive care/follow-up care, and timely appointment for specialty care. Methods The analyses used 2009 data from the National Survey of Federally Qualified Health Centers. The study included 776 of the FQHCs that participated in the survey. We examined the extent of HIT use and tested the hypothesis that level of HIT capacity is associated with quality of care. Multivariable logistic regressions, reporting unadjusted and adjusted odds ratios, were used to examine whether ‘FQHCs’ HIT capacity’ is associated with the outcome measures. Results The results showed a positive association between health information technology capacity and quality of care. FQHCs with higher HIT capacity were significantly more likely to have improved quality of care, measured by the receipt of discharge summaries (OR=1.43; CI=1.01, 2.40), the use of a patient notification system for preventive and follow-up care (OR=1.74; CI=1.23, 2.45), and timely appointment for specialty care (OR=1.77; CI=1.24, 2.53). Conclusions Our findings highlight the promise of HIT in improving quality of care, particularly for vulnerable populations who seek care at FQHCs. The results also show that FQHCs may not be maximizing the benefits of HIT. Efforts to implement HIT must include strategies that facilitate the implementation of comprehensive and advanced functionalities, as well as promote meaningful use of these systems. Further examination of the role of health information systems in clinical decision-making and improvements in patient outcomes are needed to better understand the benefits of HIT in improving overall quality of care.
    Full-text · Article · Jan 2013 · BMC Health Services Research

  • No preview · Article · Oct 2011 · Journal of clinical outcomes management: JCOM
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