Learning from Primary Care Meaningful Use Exemplars

The 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act was intended to improve the quality of health care provided by incentivizing the meaningful use (MU) of electronic health records (EHR) to achieve significant improvements in care. The MU program was implemented in three stages; for each stage, submission of clinical quality measures (CQMs) was one of three major requirements for providers to receive MU incentive payments.

Primary care practices that have successfully improved their performance on CQMs can help inform improvement strategies for other practices. The goal of this project was to develop recommendations to inform Stage 3 MU CQM requirements. The research team calculated CQMs at Primary Care Practices Research Network (PPRNet) practices and captured information on how the practices implemented and used their EHRs.

The specific aims of this project were as follows:

• Calculate practice and provider level performance, achievable benchmarks of care, and a summary measure across the 22 approved 2014 CQMs that are relevant to primary care practice for at least 80 PPRNet practices that have attested for Stage 1 MU. 
• Conduct a survey of PPRNet practices to assess the association between adoption of theory-driven implementation strategies and high performance on CQM for 22 approved 2014 CQMs relevant to primary care practice. 
• Conduct focus group interviews with providers from PPRNet with high CQM performance to triangulate findings from the second aim, and systematically solicit recommendations to improve Stage 3 MU CQM objectives. 

Analysis of cross-sectional data from the EHRs found high variability in CQM performance at participating practices. Practices used several theoretically sound quality improvement strategies including staff education, EHR reminders, standing orders, and EHR-based patient education. Among these, EHR reminders were most frequently associated with improved CQM performance. Focus group participants advocated for evidence-based CQMs, CQMs that reflect high-priority conditions in primary care, and for reducing the reporting burden for providers. The researchers report that this was the first study to assess associations between CQM performance and EHR implementation at a large sample of primary care practices.