PURPOSE Health information technology (IT) offers promising tools for improving care coordination. We assessed the feasibility and acceptability of 6 proposed care coordination objectives for stage 3 of the Centers for Medicare and Medicaid Services electronic health record incentive program (Meaningful Use) related to referrals, notification of care from other facilities, patient clinical summaries, and patient dashboards. METHODSWe surveyed physician-owned and hospital/health system-affiliated primary care practices that achieved patient-centered medical home recognition and participated in the Meaningful Use program, and community health clinics with patient-centered medical home recognition (most with certified electronic health record systems). The response rate was 35.1%. We ascertained whether practices had implemented proposed objectives and perceptions of their importance. We analyzed the association of organizational and contextual factors with self-reported use of health IT to support care coordination activities.RESULTS Although 78% of the 350 respondents viewed timely notification of hospital discharges as very important, only 48.7% used health IT systems to accomplish this task. The activity most frequently supported by health IT was providing clinical summaries to patients, in 76.6% of practices; however, merely 47.7% considered this activity very important. Greater use of health IT to support care coordination activities was positively associated with the presence of a nonclinician responsible for care coordination and the practice's capacity for systematic change.CONCLUSIONS Even among practices having a strong commitment to the medical home model, the use of health IT to support care coordination objectives is not consistent. Health IT capabilities are not currently aligned with clinicians' priorities. Many practices will need financial and technical assistance for health IT to enhance care coordination. Ann Fam Med 2015;13:250-256. doi: 10.1370/afm.1797. INTRODUCTIONC oordinating patient care is important for several reasons including the delivery of consistent guidance and recommendations, avoidance of unnecessary and/or duplicative testing, and ensuring timely access to services. A recent national survey showed that onethird of patients reported experiencing a gap in exchange of information between health care professionals involved in their care or between themselves and their health care professionals. Electronic health records (EHRs) and other health information technology (IT) offer the promise of making information sharing easier. 2Existing research shows infrequent use of health IT for care coordination, however. 3,4 Even in settings where use of health IT is widespread, connectivity with other practices or facilities can be difficult.3 Beyond the technical challenges to information sharing, other factors such as internal workflows and lack of reimbursement for care coordination can limit successful use of health IT for care coordination. 2,5,6 Suzanne Morton, MPH METHODS Over...

PURPOSEResearch on the patient-centered medical home (PCMH) model and practice redesign has not focused on the unique challenges and strengths of very small primary care practices serving disadvantaged patient populations. We analyzed the practice characteristics, prior experiences, and dimensions of the PCMH model that exist in such practices participating in the Primary Care Information Project (PCIP) of the New York City Department of Mental Health and Hygiene. METHODSWe obtained descriptive data, focusing on PCMH, for 94 primary care practices with 5 or fewer clinicians serving high volumes of Medicaid and minority patient populations in New York City. Data included information extracted from PCIP administrative data and survey data collected specifi cally for this study.RESULTS Survey results indicated substantial implementation of key aspects of the PCMH among small practices serving disadvantaged patient populations, despite considerable potential challenges to achieving PCMH implementation. Practices tended to use few formal mechanisms, such as formal care teams and designated care or case managers, but there was considerable evidence of use of informal team-based care and care coordination nonetheless. It appears that many of these practices achieved the spirit, if not the letter, of the law in terms of key dimensions of PCMH.CONCLUSIONS Small practices can achieve important aspects of the PCMH model of primary care, often with informal rather than formal mechanisms and strategies. The use of fl exible, less formal strategies is important to keep in mind when considering implementation and assessment of PCMH-like initiatives in small practices.

Providers can successfully adjust to the EHR and over time are better able to meaningfully use the EHR.