The HITECH Act laid out a broad and ambitious approach to encourage providers to adopt and use health IT in ways that are expected to improve the quality, safety and efficiency of care. The centerpiece is financial incentives for providers who implement electronic health records (EHRs) and use them in accordance with federally-specified meaningful use criteria. Criteria that promote care coordination are heavily emphasized because of the potential for EHRs, coupled with electronic health information exchange (HIE), to enable patients' health information to follow them between delivery settings.
Care coordination criteria focus on summary care record exchange and reconciliation of medications, medication allergies, and problems. These criteria were, however, largely deferred to later stages of meaningful use because of the unique they pose unique challenges. Namely, providers need to learn how to use EHRs to generate key pieces of information that should follow patients between settings, providers need the capability to engage in HIE, and providers need to become accustomed to receiving and incorporating data from other settings into clinical decisions.
Most providers have little experience exchanging or using electronically shared clinical data, limiting the understanding of how to ensure that the national investment in health IT results in more coordinated care. This project will generate evidence on current readiness to meet proposed Stage 3 care coordination criteria in primary care practices and identify the underlying barriers and facilitators that enable criteria achievement. This project will also assess whether criteria achievement improves care coordination, and identify practice-led and policy-driven strategies that increase the extent to which EHR use results in well- coordinated care.
To achieve the project’s goals, the research will comprise of a mixed-methods study that will include a statewide survey of primary care practices in Michigan that have attested to Stage 1 meaningful use. This will be complemented by qualitative and quantitative analyses of the experience implementing Stage 3 care coordination measures, and the perceived impact on care coordination, in 15 primary care practices. The study’s findings will help ensure that final Stage 3 care coordination criteria are evidence-based, and will set targets that are both achievable and result in substantial gains. They will also guide practices on optimal strategies for using EHRs to improve care coordination.