Statewide Implementation of Electronic Health Records

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.