Synthesizing Lessons Learned Using Health Information Technology

The Practice Partner Research Network (PPRNet), a practice-based research network consisting of more than 224 physician practices using a common electronic medical record (EMR), established a theoretically informed framework for translating research into practice (TRIP) in small- to medium-sized primary care practices. The PPRNet-TRIP Quality Improvement (QI) model included three components: an intervention model; an improvement model; and a practice development model that helps practices implement strategies to improve selected performance measures. 

This project synthesized what was learned from PPRNet-TRIP regarding how to use health information technology (IT) to improve quality in primary care practices. The project used mixed-methods, including secondary data analysis of seven PPRNet studies funded since 2001, and interviews of practice members participating in these studies. 

The specific aims of this project were to:

• Complete a mixed-methods secondary analysis to synthesize findings related to improving quality using health IT in primary care across seven nationally funded PPRNet initiatives.
• Examine current perspectives of PPRNet-TRIP study practice participants related to developing and sustaining QI efforts and team development for an increasingly active health care delivery role through robust EMR implementation.
• Integrate findings from PPRNet’s previous studies with the current perspectives of practice representatives to refine the overarching theory-based PPRNet-TRIP QI model.

Secondary analysis data included field notes and observations at practice site visits, network meetings, memos, correspondence, and practice member interviews. All data was merged within a database for qualitative analysis. A cross-case analysis generated important themes, provided new insights, and generated new hypotheses about factors that improve the quality of care through the use of EMRs. The framework developed included four key concepts found to drive improvement efforts: 1) develop a team care practice; 2) adapt and use health IT tools; 3) transform practice culture and quality; and 4) activate patients. This framework was reviewed and validated by practice members and co-investigators of the project. The new framework provides practical guidance for practices that are undertaking efforts to achieve meaningful use, obtain patient-centered medical home recognition, and create paths for improved financial resources pertaining to quality improvement in primary care practice.