Health Information Systems in Small Practices

Shih, Sarah C.; McCullough, Colleen; Wang, Jason; Singer, Jesse; Parsons, Amanda

doi:10.1016/j.amepre.2011.07.024

Cited by 22 publications

(9 citation statements)

References 27 publications

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“…These findings suggest that small practices in disadvantaged areas may need considerable help to use EHRs to improve quality, and lend some support for the Regional Extension Center model of assisting practices use EHRs. (29, 30) However, it should be noted that the practices in this study received assistance from PCIP, an experienced and well-funded organization that also provided funding to assist practices obtain appropriate software. It will be important to compare the effectiveness of different regional extension centers to each other, and to evaluate these effects over the long term.…”

Section: Resultsmentioning

confidence: 99%

Small Physician Practices In New York Needed Sustained Help To Realize Gains In Quality From Use Of Electronic Health Records

et al. 2013

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While Regional Extension Centers and other national policy efforts to increase the adoption of electronic health records (EHR) have been implemented in the United States, the relationship between EHR adoption and quality of care remains poorly understood. We evaluated the early effects on quality of the Primary Care Information Project, which provides subsidized EHRs and technical assistance to primary care practices in underserved neighborhoods in New York City. We find that nine or more months of participation in the Primary Care Information Project is associated with improved quality, but only for certain quality measures and only for physicians receiving extensive technical assistance.

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Section: Resultsmentioning

confidence: 99%

Small Physician Practices In New York Needed Sustained Help To Realize Gains In Quality From Use Of Electronic Health Records

et al. 2013

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“…The estimates are characterized further by size of the healthcare practice and whether studies included cost of development and implementation, ongoing cost of operations, or both. Nine(18, 21–23, 25, 27, 30–33) of the 12 studies reported the intervention cost of CDSS implementations specifically (Table 2). Of the remaining three studies, two studies that provided the cost of intervention did not include the cost of CDSS, with one(35) reporting the cost of adding provider incentives to the CDSS implementation and the second(36) providing only the labor cost of the staff involved in team-based care.…”

Section: Resultsmentioning

confidence: 99%

“…Eight studies reported the intervention cost of EHR-embedded CDSS, of which five(18, 22, 23, 31–33) included both cost of development and implementation and ongoing cost of operation and three(21, 25, 27) included only the one-time cost of development and implementation. Among the five studies that provided reasonably complete assessments of intervention cost, the mean annual costs were: $102 per patient(18, 23, 32, 33) and $6,056 per practice(18, 23) for small practices, and $49 per patient and $35,201 per practice(22, 31) for medium-sized practices.…”

Section: Resultsmentioning

confidence: 99%

Cost and economic benefit of clinical decision support systems for cardiovascular disease prevention: a community guide systematic review

Jacob

Thota

Chattopadhyay

et al. 2017

Journal of the American Medical Informatics Association

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Objective This review evaluates costs and benefits associated with acquiring, implementing, and operating clinical decision support systems (CDSS) to prevent cardiovascular disease (CVD). Materials and Methods Methods developed for The Community Guide were used to review CDSS literature covering the period from January 1976 to October 2015. Twenty-one studies were identified for inclusion. Results It was difficult to draw a meaningful estimate for the cost of acquiring and operating CDSS to prevent CVD from the available studies (n=12) due to considerable heterogeneity. Several studies (n=11) indicated healthcare costs were averted by using CDSS but many were partial assessments that did not consider all components of healthcare. Four cost-benefit studies reached conflicting conclusions about the net benefit of CDSS based on incomplete assessments of costs and benefits. Three cost-utility studies indicated inconsistent conclusions regarding cost-effectiveness based on a conservative $50,000 threshold. Discussion Intervention costs were not negligible but specific estimates were not derived because of the heterogeneity of implementation and reporting metrics. Expected economic benefits from averted healthcare cost could not be determined with confidence because many studies did not fully account for all components of healthcare. Conclusion We were unable to conclude whether CDSS for CVD prevention is either cost-beneficial or cost effective. Several evidence gaps are identified, most prominently the lack of information about major drivers of cost and benefit; the lack of standard metrics for the cost of CDSS; and not allowing for useful life of CDSS that generally extends beyond one accounting period.

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“…Reminders are displayed in a nonintrusive manner to avoid workflow interruption and to facilitate ordering diagnostic tests, prescribing recommended medications, and intervening with relevant counseling. 23 …”

Section: Methodsmentioning

confidence: 99%

Quality Measure Performance in Small Practices Before and After Electronic Health Record Adoption

McCullough

Wang

Parsons

et al. 2015

eGEMs

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Introduction:To date, little research has been published on the impact that the transition from paper-based record keeping to the use of electronic health records (EHR) has on performance on clinical quality measures. This study examines whether small, independent medical practices improved in their performance on nine clinical quality measures soon after adopting EHRs.Methods:Data abstracted by manual review of paper and electronic charts for 6,007 patients across 35 small, primary care practices were used to calculate rates of nine clinical quality measures two years before and up to two years after EHR adoption.Results:For seven measures, population-level performance rates did not change before EHR adoption. Rates of antithrombotic therapy and smoking status recorded increased soon after EHR adoption; increases in blood pressure control occurred later. Rates of hemoglobin A1c testing, BMI recorded, and cholesterol testing decreased before rebounding; smoking cessation intervention, hemoglobin A1c control and cholesterol control did not significantly change.Discussion:The effect of EHR adoption on performance on clinical quality measures is mixed. To improve performance, practices may need to develop new workflows and adapt to different documentation methods after EHR adoption.Conclusions:In the short term, EHRs may facilitate documentation of information needed for improving the delivery of clinical preventive services. Policies and incentive programs intended to drive improvement should include in their timelines consideration of the complexity of clinical tasks and documentation needed to capture performance on measures when developing timelines, and should also include assistance with workflow redesign to fully integrate EHRs into medical practice.

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Health Information Systems in Small Practices

Cited by 22 publications

References 27 publications

Small Physician Practices In New York Needed Sustained Help To Realize Gains In Quality From Use Of Electronic Health Records

Small Physician Practices In New York Needed Sustained Help To Realize Gains In Quality From Use Of Electronic Health Records

Cost and economic benefit of clinical decision support systems for cardiovascular disease prevention: a community guide systematic review

Quality Measure Performance in Small Practices Before and After Electronic Health Record Adoption

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