A Partnership for Clinician Electronic Health Record (EHR) Use and Quality of Care

With the emphasis on health information technology (IT) in ambulatory care deriving from the Health Information Technology for Economic and Clinical Health (HITECH) act, current use of electronic health records (EHRs) in ambulatory settings is increasing. However, after a health center makes a financial investment in an EHR, barriers—including the need to redesign workflow to incorporate use of the EHR before, during, and after a patient visit—to full and effective use of the system remain. It is especially important for clinical decision support systems that these barriers be overcome, because if information is not available at the point-of-care for decisionmaking, health IT cannot improve the quality and outcomes of care.

This study explored the challenges to adopting EHRs in safety net practices including nurse-managed health centers (NMHCs) and federally-qualified health centers (FQHCs). The project helped these centers assess their organizational readiness for EHRs to foster vision, incentives, resources, skills, and action plans; and to provide guided implementation through an industry partnership. Three NMHCs and three FQHCs participated in this effort to improve the quality of preventive care, chronic disease management, and medication management for vulnerable populations. These partners have a record of highly productive research, successful EHR implementation, commitment to data-supported high-quality health care for vulnerable populations, and a history of building and maintaining strong collaborations. The specific aims of the project were to:

• Study the effectiveness of a partnership that shares resources and uses a data-driven approach to promote full use of an EHR by clinicians in settings that serve vulnerable populations to improve the quality of care in the areas of preventive care, chronic disease management, and medication management.
• Test the links between clinician use of an EHR and quality of preventive care, chronic disease management, and medication safety.
• Examine organizational processes in the implementation and full use of an EHR in relationship to care delivery and outcomes.

The research design incorporated quantitative and qualitative methods as well as individual- and center-level analyses. Data were collected and analyzed using a longitudinal design to examine the developmental pattern of clinician use of EHR and its temporal association with various performance, outcome, and medication safety measures. NMHCs went live during the course of the study, allowing for comparison of pre- and post-data. FQHCs went live on the EHR prior to the study. As a result, their longitudinal data was not expected to show trends related to go-live, and no pre-implementation or during implementation data were collected from these three FQHCs.

The project demonstrated that careful EHR implementation in a model of sustained partnership focusing on the quality of EHR use by clinicians had a positive impact on quality of care and experience of care by clinicians. The project showed that ongoing partnership support of centers facing significant implementation barriers can lead to successful outcomes.