The Journey of Primary Care Practices to Meaningful Use

A Colorado Beacon Consortium Study

Douglas H. Fernald, MA; Robyn Wearner, RD; W. Perry Dickinson, MD

Disclosures

J Am Board Fam Med. 2013;26(5):603-611. 

In This Article

Abstract and Introduction

Abstract

Background: The Health Information Technology for Economic and Clinical Health Act of 2009 provides for incentive payments through Medicare and Medicaid for clinicians who implement electronic health records (EHRs) and use this technology meaningfully to improve patient care. There are few comprehensive descriptions of how primary care practices achieve the meaningful use of clinical data, including the formal stage 1 meaningful use requirements.

Methods: Evaluation of the Colorado Beacon Consortium project included iterative qualitative analysis of practice narratives, provider and staff interviews, and separate focus groups with quality improvement (QI) advisors and staff from the regional health information exchange (HIE).

Results: Most practices described significant realignment of practice priorities and aims, which often required substantial education and training of physicians and staff. Re-engineering office processes, data collection protocols, EHRs, staff roles, and practice culture comprised the primary effort and commitment to attest to stage 1 meaningful use and subsequent meaningful use of clinical data. While realizing important benefits, practices bore a significant burden in learning the true capabilities of their EHRs with little effective support from vendors. Attestation was an important initial milestone in the process, but practices faced substantial ongoing work to use their data meaningfully for patient care and QI. Key resources were instrumental to these practices: local technical EHR expertise; collaborative learning mechanisms; and regular contact and support from QI advisors.

Conclusions: Meeting the stage 1 requirements for incentives under Medicare and Medicaid meaningful use criteria is the first waypoint in a longer journey by primary care practices to the meaningful use of electronic data to continuously improve the care and health of their patients. The intensive re-engineering effort for stage 1 yielded practice changes consistent with larger practice aims and goals. While many of these practices are now poised to use data meaningfully, faster progress will likely come with continued local QI and technical support and planned community-wide learning.

Introduction

As part of the American Recovery and Reinvestment Act of 2009, the Health Information Technology for Economic and Clinical Health Act provided for incentive payments through the Centers for Medicare and Medicaid Services (CMS) for clinicians who use electronic health records (EHRs) according to meaningful use criteria.[1] Practices often have struggled with the implementation of EHRs, focusing primarily on documentation to justify payment.[2,3] Beyond documentation, EHRs are new information management systems that can potentially transform the delivery of patient care, providing the necessary data for such things as point-of-care decision support, population management, care management, and quality improvement (QI) activities. However, the additional burden of achieving meaningful use, while necessary to achieve the full realization of benefits of the patient-centered medical home model, has been a challenge for practices.[4] Stage 1 of the CMS EHR incentive program was intended to establish a baseline for capturing electronic data and sharing information. Providers seeking the incentive offered in stage 1 had to demonstrate meaningful use of their EHR by meeting all 15 core objectives, their choice of 5 of the 10 menu objectives, and a minimum of 6 clinical quality measures (Table 1).[5]

A 2011 nationally representative survey of physicians found that while 51% of providers intended to apply for meaningful use incentives, just 11% reported having computerized capabilities to support at least 10 of the 15 core objectives for stage 1 incentives.[6] A systematic review of health information technology (IT) in practices noted significant barriers to the adoption of health IT while advocating for better understanding of the barriers to effective implementation after adoption of health IT.[7] Barriers to adoption include concerns about costs, insufficient training, practice culture, current technical limitations, and concerns that existing EHR systems do not meet the clinical needs of practices. Smaller practices in particular are more likely to have concerns about the costs associated with acquiring and integrating EHRs and that their system will become obsolete.[8]

Recognizing these problems, the Office of the National Coordinator for Health Information Technology funded 60 health IT regional extension centers (RECs) to assist clinicians in adopting and meaningfully using EHRs.[9] In addition, the Office of the National Coordinator for Health Information Technology developed the Beacon Community Cooperative Agreement Program, which provides funding to support 17 communities in building and strengthening their health IT infrastructure and exchange capabilities to improve care coordination, increase the quality of care, and slow the growth of health care spending.[10]

The Colorado Beacon Consortium (CBC), one of the 17 Beacon communities, aimed to demonstrate how costs can be reduced and patient care and population health improved through the collection, analysis, and sharing of clinical data and the redesign of primary care practices and clinics.[11] Although attestation for stage 1 meaningful use was an aim of the CBC, the consortium had goals beyond the formal CMS core and menu objectives to more broadly demonstrate how costs could be reduced and patient care and the general health of the population could be improved. As an important part of its work, the CBC deployed QI advisors and health IT experts to assist practices in using data meaningfully in patient care and QI. The purpose of this article is to describe the journey, struggles, successes, and barriers to obtaining and meaningfully using electronic clinical data for QI in primary care practices participating in the CBC and to inform future work by other primary care practices seeking to meaningfully use electronic clinical data.

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