The Journey of Primary Care Practices to Meaningful Use
While most providers and administrators in our sample of practices agreed with the overall vision and purpose of meaningful use of EHRs, they also were burdened with the substantial—and at times tedious—tasks of re-engineering their offices to sufficiently meet the requirements of stage 1 attestation. The primary frustrations seemed to relate to EHRs that were limited in their capabilities for providing the necessary electronic patient data and EHR vendors that offered limited assistance.
Despite frustrations and limitations, practices benefited from their intensive re-engineering work: more consistent office processes; better data and reporting; capacity for continued QI work; early advances in efficient population-based care; a strengthened community of provider-collaborators; and connections to vital support resources.
Looking ahead to stages 2 and 3 of meaningful use and beyond, practices planned to continue to re-engineer their practices to meet new requirements and new data demands; however, several practices expressed clear concern for the availability of EHRs that will be certified for stage 2meaningful use. As one physician asked, "How many EHRs will disappear because they can't meet stage 2 certification [requirements]?" It will not be easy for practices to change EHRs, pay for upgrades, and overcome technical issues without local and timely technical support.
Furthermore, while practices made significant progress in their re-engineering to adapt to new and ongoing changes, a key resource needed to facilitate ongoing changes are local advisors who help to sustain QI momentum in practices while sustaining vital local connections and collaboration among communities of providers and clinical practices.
Limitations for these analyses include the potential lack of generalizability of the sample, which consisted of small to intermediate-sized independent practices in a specific geographic region that agreed to participate in the CBC and may not be representative of other types of practices. Without comparison data from a larger sample of practices, we were unable to determine whether these results are unique to the CBC practices. Even within this sample of practices, experiences were quite variable. Other important barriers and resources may also exist.
Policies and incentive programs that continue to support community and regional resources that provide practices with direct, local EHR expertise, collaborative learning structures and venues, and practice QI advisors may be an efficient and necessary use of resources to sustain heath IT-based QI efforts in practices that are likely to face ongoing technical challenges. Further alignment of private sector strategies that complement Medicare and Medicaid meaningful use incentives could accelerate adoption and use of health IT. Without these resources, useful patient data may languish as providers and staff spend precious time to remedy technical barriers while implementing new or changed guidelines, programs, and improvements.
Discussion
While most providers and administrators in our sample of practices agreed with the overall vision and purpose of meaningful use of EHRs, they also were burdened with the substantial—and at times tedious—tasks of re-engineering their offices to sufficiently meet the requirements of stage 1 attestation. The primary frustrations seemed to relate to EHRs that were limited in their capabilities for providing the necessary electronic patient data and EHR vendors that offered limited assistance.
Despite frustrations and limitations, practices benefited from their intensive re-engineering work: more consistent office processes; better data and reporting; capacity for continued QI work; early advances in efficient population-based care; a strengthened community of provider-collaborators; and connections to vital support resources.
Looking ahead to stages 2 and 3 of meaningful use and beyond, practices planned to continue to re-engineer their practices to meet new requirements and new data demands; however, several practices expressed clear concern for the availability of EHRs that will be certified for stage 2meaningful use. As one physician asked, "How many EHRs will disappear because they can't meet stage 2 certification [requirements]?" It will not be easy for practices to change EHRs, pay for upgrades, and overcome technical issues without local and timely technical support.
Furthermore, while practices made significant progress in their re-engineering to adapt to new and ongoing changes, a key resource needed to facilitate ongoing changes are local advisors who help to sustain QI momentum in practices while sustaining vital local connections and collaboration among communities of providers and clinical practices.
Limitations for these analyses include the potential lack of generalizability of the sample, which consisted of small to intermediate-sized independent practices in a specific geographic region that agreed to participate in the CBC and may not be representative of other types of practices. Without comparison data from a larger sample of practices, we were unable to determine whether these results are unique to the CBC practices. Even within this sample of practices, experiences were quite variable. Other important barriers and resources may also exist.
Policies and incentive programs that continue to support community and regional resources that provide practices with direct, local EHR expertise, collaborative learning structures and venues, and practice QI advisors may be an efficient and necessary use of resources to sustain heath IT-based QI efforts in practices that are likely to face ongoing technical challenges. Further alignment of private sector strategies that complement Medicare and Medicaid meaningful use incentives could accelerate adoption and use of health IT. Without these resources, useful patient data may languish as providers and staff spend precious time to remedy technical barriers while implementing new or changed guidelines, programs, and improvements.
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