Assessing Readiness, Achievement & Impact of Stage 3 Care Coordination Criteria

The Medicare and Medicaid Electronic Health Record (EHR) Incentive Program, established with funding from the 2009 Health Information Technology for Economic and Clinical Health Act (HITECH), offers financial incentives for eligible providers and hospitals to adopt and demonstrate meaningful use of EHRs. Meaningful Use (MU) is defined in stages that require increasingly advanced and sophisticated use of EHRs. Proposed Stage 3 MU criteria placed an increased emphasis on care coordination: specifically, the ability to electronically send, receive, and incorporate information between providers’ EHRs during transitions of care. Researchers at the University of Michigan, in partnership with the Altarum Institute, were funded by the Agency for Healthcare Research and Quality to assess the readiness, feasibility, and perceived impact of achieving proposed Stage 3 MU care coordination criteria among primary care practices.

The specific aims of the project were as follows:

• Assess current readiness of eligible primary care practices to achieve proposed Stage 3 care coordination criteria in order to inform policy driven improvement strategies. 
• Identify barriers and associated facilitators to meeting proposed Stage 3 care coordination criteria in order to help practices overcome gaps to criteria achievement. 
• Assess the potential impact of proposed Stage 3 care coordination criteria and identify strategies to increase the value of the criteria to primary care practices. 

The investigators conducted a mixed-methods study comprised of a statewide survey of Michigan primary care practices and an implementation assessment in which 12 practices attempted to achieve the proposed criteria. The study assessed provider experience in three rounds of semi-structured interviews, which were coded and analyzed to identify key themes.

In both study components, while providers anticipated that meeting the criteria would improve care coordination, most practices lacked the EHR functionalities and workflows to meet them. Based on study findings, the investigators recommended revisions to the criteria to improve their value–-primarily related to increased specificity and higher thresholds. These changes would be enhanced by efforts from EHR vendors to improve design and diffusion of innovations that support care coordination. Researchers also recommended that innovations related to the customization of transition-of-care documents, task tracking, and automated reconciliation should be prioritized. Finally, the investigators suggested that specific practice-based strategies would further enhance care coordination and the value of meeting the Stage 3 criteria. These strategies relate to learning more about existing EHR and health information exchange functionalities, and shifting EHR-related care coordination tasks from physicians to support staff where appropriate.