Using Health Information Technology to Improve Health Care Quality in Primary Care Practices and in Transitions between Care Settings (Oklahoma)

Project Final Report (PDF, 2.85 MB)

Project Details - Ended

Project Categories

Summary:

A fundamental feature of a national health care network is the ability to share local health information residing in electronic health records (EHRs) and other databases through health information exchange (HIE) within and between regional health information organizations (RHIOs). A major barrier to RHIO use, however, may be the lack of a convincing value proposition for providers. While investing in information-sharing between health care organizations appears to have a societal net-benefit, the return on investment for individual medical practices—especially smaller practices—is less certain. Medical practices incur most of the costs of adopting new information-sharing technologies, while health insurers and patients receive most of the benefits. Apart from capital expenses and fees, medical practices must adapt their workflow to benefit from HIE technology. Many medical practices lack managers with the necessary implementation skills and experience. There is scant research on which specific features of existing HIEs are most useful in primary care, what new features are needed, and how these features can be incorporated into primary care workflow and care processes. 

This project documented, studied, and reported the engagement of six primary care practices that use EHRs that were linked to the Secure Medical Records Transfer Network (SMRTNET) through a local data repository. SMRTNET provides access to a broad range of information—including hospital records, laboratory tests, pharmacy records, and a statewide immunization registry—from a variety of sources. As part of this project, SMRTNET was enhanced with the Web-based Preventive Services Reminder System (PSRS), a comprehensive clinical tool for improving the delivery of patient-centered preventive services through a patient registry, prompt and reminder system, clinical decision support, and quality improvement tool that were accessible through a simple, secure Web interface. 

The specific objectives of the project were to:

  • Enhance the current features of SMRTNET by including the PSRS preventive services recommendation engine.
  • Test the usefulness and acceptability of the HIE technology intervention.
  • Develop an implementation guide that describes the principles and steps required to implement HIE-connections between disparate data systems and documents potential benefits of and barriers to implementation.

The project tested the usefulness, acceptability and ability of an HIE to promote data exchange across local and statewide health care systems through a single interface to multiple EHRs. While many aspects of this HIE infrastructure development were specific to the systems being studied, the research team believed that this type of connection between adjacent health care delivery regions was likely to be implemented throughout the United States.

Analysis of the results of this implementation yielded generalizable and useful knowledge about best practices for HIE implementation to facilitate patient-centered care in primary care settings. Based on observations and data analyses, the study team produced an implementation guide to provide a blueprint for building a clinical data exchange for transitions between care settings, authored a manuscript reporting their findings, and developed a final report. 

PSRS was adopted to a varying degree by different practices at the beginning of the project. Adoption depended upon the availability of actionable clinical data to drive the decision-support engine. However, in the course of the project, both the adoption of the clinical decision-support system and measured performance of providers for specific processes of care and medication management improved. Documentation of completed mammograms increased from 22.1 to 57.1 percent; documentation of colonoscopy increased from 31.7 to 53.8 percent; documentation of pneumococcal immunization increased from 39.1 to 50.6 percent; and influenza immunization documentation increased from 22.7 to 41.7 percent. In addition, medication reconciliation improved from 35.3 to 44.9 percent. Medication reconciliation expressed as the ratio of matching patient-reported and clinician-recorded lists of medications also improved significantly from 35.3 to 44.9 percent. Time-motion studies suggested that 17 percent of the time clinicians and staff spent were redistributed from administration and information seeking to more direct, care-related activities.

Using Health Information Technology to Improve Health Care Quality in Primary Care Practices and in Transitions between Care Settings - 2012

Summary Highlights

  • Principal Investigator: 
  • Funding Mechanism: 
    Primary Care Practice-Based Research Network (PBRN)
  • Contract Number: 
    290-07-10009-5
  • Project Period: 
    September 2009 – September 2012
  • AHRQ Funding Amount: 
    $332,000
  • PDF Version: 
    (PDF, 379.09 KB)

Summary: A fundamental feature of a national health care network is the ability to share local health information residing in electronic health records (EHRs) and other databases through health information exchange (HIE) within and between regional health information organizations (RHIOs). A major barrier to RHIO use, however, may be the lack of a convincing value proposition for providers. While investing in information-sharing between health care organizations appears to have a societal net-benefit, the return on investment for individual medical practices—especially smaller practices—is less certain. Medical practices incur most of the costs of adopting new information-sharing technologies, while health insurers and patients receive most of the benefits. Apart from capital expenses and fees, medical practices must adapt their workflow to benefit from HIE technology. Many medical practices lack managers with the necessary implementation skills and experience. There is scant research on which specific features of existing HIEs are most useful in primary care, which new features are needed, and how these features can be incorporated into primary care workflow and care processes.

This project documented, studied, and reported the engagement of six primary care practices that use EHRs that are linked to the Secure Medical Records Transfer Network (SMRTNET) through a local data repository. SMRTNET provides access to a broad range of information—including hospital records, laboratory tests, pharmacy records, and a statewide immunization registry—from a variety of sources. As part of this project, SMRTNET was enhanced with the Web-based Preventive Services Reminder System (PSRS), a comprehensive clinical tool for improving the delivery of patient-centered preventive services through a patient registry, prompt and reminder system, clinical decision support, and quality improvement tool that were accessible through a simple, secure Web interface.

The project tested the usefulness, acceptability, and ability of an HIE to promote data exchange across local and statewide health care systems through a single interface to multiple EHRs. While many aspects of this HIE infrastructure development were specific to the systems being studied, the research team believed that this type of connection between adjacent health care delivery regions was likely to be implemented throughout the United States. Analysis of the results of this implementation yielded generalizable and useful knowledge about best practices for HIE implementation to facilitate patient-centered care in primary care settings. Based on observations and data analyses, the study team produced an implementation guide to provide a blueprint for building a clinical data exchange for transitions between care settings, authored a manuscript reporting their findings, and developed a final report. 

Project Objectives: 

  • Enhance the current features of SMRTNET by including the PSRS preventive services recommendation engine. (Achieved) 
  • Test the usefulness and acceptability of the HIE technology intervention. (Achieved) 
  • Develop an implementation guide that describes the principles and steps required to implement HIE-connections between disparate data systems and documents potential benefits of and barriers to implementation. (Achieved)  

2012 Activities: The study team supported practice adoption and use of SMRTNET during this period. Postimplementation data were collected and compared to baseline data. The team developed Regional Health eDecisions: A Guide to Connecting Health Information Exchange in Primary Care (PDF, 2.85 MB), an implementation guide that provides the principles and steps involved in implementing HIE-connections.

Impact and Findings: At the beginning of the project different practices adopted PSRS to varying degrees, depending upon the availability of actionable clinical data to drive the decision-support engine. Over the course of the project both the adoption of the clinical decision-support system and measured performance of providers for specific processes of care and medication management improved. Documentation of completed mammograms increased from 22.1 to 57.1 percent; documentation of colonoscopy increased from 31.7 to 53.8 percent; documentation of pneumococcal immunization increased from 39.1 to 50.6 percent; and influenza immunization documentation increased from 22.7 to 41.7 percent. In addition, medication reconciliation improved from 35.3 to 44.9 percent. Medication reconciliation expressed as the ratio of matching patient-reported and clinician-recorded lists of medications also improved significantly, from 35.3 to 44.9 percent. Time-motion studies suggested that 17 percent of the time clinicians and staff spent were redistributed from administration and information seeking to more direct, care-related activities.

Target Population: General

Strategic Goal: Develop and disseminate health IT evidence and evidence-based tools to support patient-centered care, the coordination of care across transitions in care settings, and the use of electronic exchange of health information to improve quality of care.

Business Goal: Knowledge Creation

Using Health Information Technology to Improve Health Care Quality in Primary Care Practices and in Transitions between Care Settings - 2011

Summary Highlights

Summary: A fundamental feature of a national health care network is the ability to share electronic health records (EHRs) from local health information exchange (HIE) hubs through regional health information organizations (RHIOs). A major barrier to RHIO use, however, is the lack of a convincing value proposition for providers. While there appears to be a net societal benefit from investments in sharing information among health care organizations, the return on investment for individual medical practices-especially smaller practices-is less certain. Medical practices incur most of the costs of adopting new information sharing technology, while health insurers and patients receive most of the benefits. Apart from capital expenses and fees, medical practices must adapt their workflow to benefit from RHIO technology. Many medical practices lack managers with the necessary implementation skills and experience. There is scant research on which specific features of existing RHIOs are most useful in primary care, what new features are needed, and how these features can be incorporated into primary care workflow and care processes.

This project documents, studies, and reports the engagement of six primary care practices that use EHRs and are linked through a local HIE hub in a RHIO called Secure Medical Records Transfer Network (SMRTNET). SMRTNET provides access to a broad range of information-including hospital records, laboratory tests, pharmacy records, and a statewide immunization registry-from a variety of sources. As part of this project, SMRTNET was enhanced with the Web-based Preventive Services Reminder System (PSRS), a comprehensive clinical tool for improving the delivery of patient-centered preventive services through a patient registry, prompt/reminder functionality, clinical decision support, and quality improvement (audit) functions that are accessible through a simple, secure Web interface.

The project tests the usefulness and acceptability of a RHIO's ability to promote HIE across both local and statewide health care systems as a single point of attachment (i.e., a single interface rather than separate interfaces for multiple EHR systems) for the PSRS software application. While many aspects of this HIE infrastructure development are specific to the two systems being studied, the research team believes that this type of connection between HIE systems and RHIOs is likely to be implemented throughout the United States. Analysis of the results of this implementation will yield generalizable and useful knowledge about best practices for HIE facilitation of patient-centered care in primary care provider settings. Furthermore, the research team anticipates that Federal incentives, funding, penalties, and requirements under the American Recovery and Reinvestment Act of 2009's Meaningful Use standards will accelerate the combined use of EHRs and RHIOs.

Based on observations and data analysis, the study team will produce an implementation guide to disseminate this type of health information technology system to other practices, at least one published manuscript reporting their findings, and a final report. The plan for disseminating the technology to primary care practices will be developed in collaboration with the Agency for Healthcare Research and Quality.

Project Objectives:

  • Enhance the current features of SMRTNET by including the PSRS software program. (Achieved)
  • Test the usefulness and acceptability of the technology intervention. (Ongoing)
  • Develop an implementation guide that provides the principles and steps required to implement connections between such systems and documents potential benefits from and barriers to implementation. (Ongoing)

2011 Activities: There were delays in developing PSRS interfaces with eClinicalWorks and SMRTNET. After meeting with software vendors, substantial progress in the SMRTNet-eClinicalWorks hub connection and some progress on SMRTNET-PSRS connection was made. The SMRTNet-eClinicalWorks hub connection is operational. Significant progress was made in establishing the SMRTNET-PSRS connection. By the end of 2011, most of the software issues had been corrected and providers were re-oriented to the PSRS and SMRTNET access from the eClinicalWorks interface. Because of these delays, the contract was extended by 12-months to complete the project and will end in September 2012.

Preliminary Impact and Findings: The project has no findings to date.

Target Population: Not Applicable

Strategic Goal: Develop and disseminate health IT evidence and evidence-based tools to support patient-centered care, the coordination of care across transitions in care settings, and the use of electronic exchange of health information to improve quality of care.

Business Goal: Knowledge Creation

Using Health Information Technology to Improve Health Care Quality in Primary Care Practices and in Transitions between Care Settings - 2010

Summary Highlights



Target Population: Not Applicable

Summary: A fundamental feature of a national health care network is the ability to share electronic health records (EHRs) from local health information exchange (HIE) hubs through regional health information organizations (RHIOs). A major barrier to RHIO use, however, is the lack of a convincing value proposition for providers. While there appears to be a net societal benefit from investments in sharing information among health care organizations, the return on investment for individual medical practices—especially smaller practices—is less certain. Medical practices incur most of the costs of adopting new information sharing technology, while health insurers and patients receive most of the benefits. Apart from capital expenses and fees, medical practices must adapt their workflow to benefit from RHIO technology. Many medical practices lack managers with the necessary implementation skills and experience. Little research has been done to determine the specific features of existing RHIOs that are most useful in primary care, what new features are needed, and how these features can be incorporated into primary care work flow and care processes.

This project documents, studies, and reports on the engagement of six primary care practices that use EHRs and are linked through a local HIE hub in a RHIO called Secure Medical Records Transfer Network (SMRTNET). SMRTNET provides access to a broad range of information—including hospital records, laboratory tests, pharmacy records, and a statewide immunization registry—from a variety of sources. As part of this project, SMRTNET will be enhanced with the Web-based Preventive Services Reminder System (PSRS), a comprehensive clinical tool for improving the delivery of patient-centered preventive services through a patient registry, prompt/reminder functionality, clinical decision support, and quality improvement (audit) functions that are accessible through a simple, secure Web interface.

The project tests the usefulness and acceptability of a RHIO’s ability to promote HIE across both local and statewide health care systems as a single point of attachment (i.e., a single interface rather than separate interfaces for multiple EHR systems) for a software application – the PSRS. While many aspects of this HIE infrastructure development are specific to the two systems being studied, the research team believes that this type of connection between HIE systems and RHIOs is likely to be implemented around the United States. Analysis of the results of this implementation will yield generalizable and useful knowledge about best practices for HIE facilitation of patient-centered care in primary care provider settings. Furthermore, the research team anticipates that Federal incentives, funding, penalties, and requirements under the American Recovery and Reinvestment Act of 2009’s “meaningful use” standards will accelerate the combined use of EHRs and RHIOs.

Based on observations and data analysis, the study team will produce an implementation guide to disseminate this type of health information technology system to other practices, at least one published manuscript reporting their findings, and a final report. The plan for disseminating the technology to primary care practices will be developed in collaboration with the Agency for Healthcare Research and Quality (AHRQ).

Project Objectives:
  • Enhance the current features of SMRTNET by including the PSRS software program. (Achieved)
  • Test the usefulness and acceptability of the technology intervention. (Ongoing)
  • Develop an implementation guide that provides the principles and steps required to implement connections between such systems and documents potential benefits from and barriers to implementation. (Upcoming)

2010 Activities: Study team members visited the participating practices, interviewed practice members, administered the Practice Workflow Interview and Observation Instrument, and conducted workflow observations. Reports on laboratory test use, immunization delivery, and preventive service delivery were developed using the eClinicalWorks reporting module. An Access database was developed to collect time-motion based observation data of clinical workflows of specialists using an EHR; it was used to capture data during direct observation of physicians and nurses at site visits to participating practices. Practice-based pre-implementation data collection was completed, with the exception of time-motion based observation data.

The team worked with their AHRQ project officer to develop a dissemination and implementation plan based on goals of the project and using examples provided by previous projects. A draft of the plan was submitted for comment to the project officer. Significant delays in developing project software have postponed deployment.

Preliminary Impact and Findings: The project has no findings to date.

Strategic Goal: Develop and disseminate health IT evidence and evidence-based tools to support patient-centered care, the coordination of care across transitions in care settings, and the use of electronic exchange of health information to improve quality of care.

Business Goal: Knowledge Creation

Regional health edecisions: a guide to connecting health information exchange in primary care.

Citation:
Scheid D, Yeaman B, Nagykaldi Z, Mold J. Regional health edecisions: a guide to connecting health information exchange in primary care. (Prepared by the Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, and Norman Physician Hospital Organization, under Contract No. 290-07-10009-5.) AHRQ Publication No. 13-0018-EF. Rockville, MD: Agency for Healthcare Research and Quality. May 2013. (PDF, 2.85 MB)
Principal Investigator: 
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