Statewide Implementation of Electronic Health Records (Massachusetts)

Project Final Report (PDF, 67.36 KB) Disclaimer

Statewide Implementation of Electronic Health Records - 2008

Summary Highlights

  • Principal Investigator: 
  • Funding Mechanism: 
    RFA: HS04-011: Transforming Health Care Quality through Information Technology (THQIT)
  • Grant Number: 
    UC1 HS 015397
  • Project Period: 
    09/04 – 09/08, Including No-Cost Extension
  • AHRQ Funding Amount: 
    $1,497,154
  • PDF Version: 
    (PDF, 49.79 KB)


Strategic Goal: Develop and disseminate health IT evidence and evidence-based tools to improve the quality and safety of medication management via the integration and utilization of medication management systems and technologies.

Business Goal: Knowledge Creation

Summary: In 2005, the Massachusetts e-Health Collaborative (MAeHC) completed a proposal process for selection of three Massachusetts communities as pilots for full statewide electronic health record (EHR) implementation. The State of Massachusetts has over six million residents who are cared for by approximately 20,000 physicians in about 6,000 practices; the three selected communities represent over 150 ambulatory practices with more than 400 clinicians. Prior to this project, the MAeHC had implemented full EHRs in all of these practices and created an operational clinical data exchange platform in two of the three communities. This study comprehensively evaluated the intervention and measured trends in health information technology (IT) adoption across Massachusetts. Multiple statewide surveys of office staff and physicians addressed barriers to adoption and use of EHRs. A quasi-experimental pre-post study evaluated the effect of EHR implementation on medication errors. A randomized controlled trial assessed the effects of academic detailing on the uptake of new EHR systems. Merging survey results with claims data enabled the evaluation of the relationship between EHRs and quality of care. An additional analysis examined the relationship between EHRs and malpractice claims.

Specific Aims

  • Evaluate the effectiveness of an intervention designed to increase the rate and extent of adoption of EHRs in physicians’ offices throughout Massachusetts. (Achieved)
  • Determine the effect of EHR use on medication error rates, and determine the effects of EHR use on quality of care in primary care office practices. (Achieved)
  • Develop, pre-test, and administer a survey to Massachusetts licensed physicians before and after implementation of a multi-stakeholder collaborative intervention. (Achieved)
  • Measure the degree and correlates of physician receptivity to EHRs. (Achieved)
  • Assess the effects of the statewide program on physician receptivity to and use of EHRs. (Achieved)
  • Measure potential facilitators of EHR adoption by physicians. (Achieved)
  • Measure the effectiveness of academic detailing in fostering successful implementation and usage of EHRs among physicians adopting such systems. (Achieved)

2008 Activities: Data from the surveys on EHR use were received and analyzed over the course of 2008. Articles were readied for publication.

Impact and Findings: The most significant barriers to EHR adoption were financial, which was most apparent in small practices. While a majority of physicians had adopted EHRs by 2005, only a small fraction regularly used key functions, including clinical decision support. EHR adoption was associated with lower rates of malpractice settlements. The relationship between EHRs and quality of care is complex and depends not only on EHR adoption, but also on usage of key EHR features.

Selected Outputs

Wright A, Soran C, Jenter CA, et al. Physician attitudes toward health information exchange: results of a statewide survey. J Am Med Inform Assoc 2010;17(1):66-70.

Quinn MA, Wilcox A, Orav EJ, et al. The relationship between perceived practice quality and quality improvement activities and physician practice dissatisfaction, professional isolation, and work-life stress. Med Care 2009;47(8):924-8.

Wright A, McGlinchey EA, Poon EG, et al. Ability to generate patient registries among practices with and without electronic health records. J Med Internet Res. 2009;11(3):e31.

Rudin RS, Simon SR, Volk LA, et al. Understanding the decisions and values of stakeholders in health information exchanges: experiences from Massachusetts. Am J Public Health 2009;99(5):950-5.

Jha AK, Bates DW, Jenter C, et al. Electronic health records: use, barriers and satisfaction among physicians who care for black and Hispanic patients. J Eval Clin Pract 2009;15(1):158-63.

Goroll AH, Simon SR, Tripathi M, et al. Community-wide implementation of health information technology: the Massachusetts eHealth Collaborative experience. J Am Med Inform Assoc 2009;16(1):132-9.

Virapongse A, Bates DW, Shi P, et al. Electronic health records and malpractice claims in office practice. Arch Intern Med 2008;168(21):2362-7.

Simon SR, Kaushal R, Jenter CA, et al. Readiness for electronic health records: comparison of characteristics of practices in a collaborative with the remainder of Massachusetts. Inform Prim Care 2008;16(2):129-37.

Simon SR, McCarthy ML, Kaushal R, et al. Electronic health records: which practices have them, and how are clinicians using them? J Eval Clin Pract 2008;14(1):43-7.

Simon SR, Kaushal R, Cleary PD, et al. Correlates of electronic health record adoption in office practices: a statewide survey. J Am Med Inform Assoc 2007;14(1):110-7.

Simon SR, Kaushal R, Cleary PD, et al. Physicians and electronic health records: a statewide survey. Arch Intern Med 2007;167(5):507-12.

Jenter CA, Simon SR, Volk LA, et al. Evaluation of a statewide implementation of electronic health records. In Kuhn KA, Warren JR, Leong T-Y, editors. Medinfo 2007: Building Sustainable Health Systems. Proceedings of the 12th World Congress on Health (Medical) Informatics; 2007. Amsterdam: IOS Press; 2007. p. 2575-9.

Grantee’s Most Recent Self-Reported Quarterly Status: This project has been completed.

Milestones: Progress is mostly on track.

Budget: On target.

Project Details - Ended

Project Categories

Summary:

Electronic health records (EHRs) represent an essential tool for improving the safety and quality of health care, but most physicians in office practices do not currently use this technology. In Massachusetts, several large provider organizations utilize state-of-the art EHRs, but most physicians practicing solo or in small groups continue to rely on paper records. A statewide multistakeholder coalition had embarked on a separately funded program to facilitate the adoption of EHRs in the offices of all physicians throughout Massachusetts and to develop the interconnectivity infrastructure to enable the exchange of health information across the state.

The intervention program, which involved the implementation of full EHR systems in three pilot communities, aimed at informing a larger state-wide adoption, was a collaborative effort among providers, insurers, and businesses in Massachusetts, in cooperation with the state government. This application proposed a rigorous evaluation of the impact of this statewide implementation program on EHR adoption by rural and non-rural ambulatory care practices in Massachusetts.

This study addressed the following questions: 1) What is the current rate of EHR adoption in the state, and how does the proposed program increase the rate of adoption? 2) To what extent will adoption of EHRs reduce medication errors and improve the quality of ambulatory health care? 3) What are the correlates of physician receptivity and use of EHRs? 4) Will an intensive program of educational outreach ("academic detailing") more effectively foster the adoption of EHRs and minimize the loss of physician productivity than standard EHR implementation programs?

These questions were addressed by a stratified random sample of all office practices in the state (N~2,000), comparative analysis of medication errors in 10 primary care practices, statewide practice quality data analysis (including HEDIS measures), survey to a stratified random sample of 2,000 physicians, and a randomized controlled trial of an academic detailing intervention in a total of 30 rural and non-rural practices. This program evaluation provided much-needed information on the effectiveness of EHR implementation strategies, correlates of EHR adoption, impact on medication error and quality, and role of educational outreach to facilitate the adoption of EHRs and related health IT in communities nationwide. Dissemination of the results of this work should speed efforts toward the establishment of a national health information infrastructure.

Statewide Implementation of Electronic Health Records - Final Report

Citation:
Bates DW. Statewide Implementation of Electronic Health Records - Final Report. (Prepared by Brigham and Women's Hospital under Grant No. UC1 HS015397). Rockville, MD: Agency for Healthcare Research and Quality, 2009. (PDF, 67.36 KB)

The findings and conclusions in this document are those of the author(s), who are responsible for its content, and do not necessarily represent the views of AHRQ. No statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.
Principal Investigator: 
Document Type: 

Massachusetts Office Practice Survey

This is a questionnaire designed to be completed by administrators and clinical staff in an ambulatory setting. The tool includes questions to assess the current state of electronic health records.

Year of Survey: 
2005
Survey Link: 
Massachusetts Office Practice Survey (PDF, 238.46 KB) (Persons using assistive technology may not be able to fully access information in this report. For assistance, please contact Corey Mackison)
Copyright Status: 
Permission has been obtained from the survey developers for unrestricted use of this survey; it may be modified or used as is without additional permission from the authors.

Massachusetts Survey of Physicians and Computer Technology

This is a questionnaire designed to be completed by physicians in an ambulatory setting. The tool includes questions to assess user's perceptions of electronic health records.

Year of Survey: 
Created prior to 2008
Survey Link: 
Massachusetts Survey of Physicians and Computer Technology (PDF, 90.63 KB) (Persons using assistive technology may not be able to fully access information in this report. For assistance, please contact Corey Mackison)
Population: 
Copyright Status: 
Permission has been obtained from the survey developers for unrestricted use of this survey; it may be modified or used as is without additional permission from the authors.
This project does not have any related story.
This project does not have any related emerging lesson.