Sustaining "Meaningful Use" of Health Information Technology in Low-Resource Practices

Abstract

PURPOSEThe implementation of electronic health records (EHRs) has been extensively studied, but their maintenance once implemented has not. The Regional Extension Center (REC) program provides implementation assistance to priority practices-those with limited financial, technical, and organizational resources-but the assistance is time limited. Our objective was to identify potential barriers to maintenance of meaningful use of EHRs in priority primary care practices using a qualitative observational study for federally qualified health centers (FQHCs) and priority practices in Michigan. METHODSWe conducted cognitive task analysis (CTA) interviews and direct observations of health information technology implementation in FQHCs. In addition, we conducted semistructured interviews with implementation specialists serving priority practices to detect emergent themes relevant to maintenance. RESULTSMaintaining EHR technology will require ongoing expert technical support indefinitely beyond implementation to address upgrades and security needs. Maintaining meaningful use for quality improvement will require ongoing support for leadership and change management. Priority practices not associated with larger systems lack access to the necessary technical expertise, financial resources, and leverage with vendors to continue alone. Rural priority practices are particularly challenged, because expertise is often not available locally.CONCLUSIONS Priority practices, especially in rural areas, are at high risk for falling on the wrong side of a "digital divide" as payers and regulators enact increasing expectations for EHR use and information management. For those without affiliation to maintain the necessary expert staff, ongoing support will be needed for those practices to remain viable.

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“…; Green et al. ; Healthcare Improvement Scotland ; Infoway ). HITs can only realize their full potential if they are used as intended (or in ways that fulfill their purpose), and there is also growing realization that HIT can introduce new risks.…”

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“…Research on the quality of diabetes and cancer care in that context suggests primary care practices need support to redesign work processes with population health management targets in mind. [3] [4] [5] [6] However, the benefits of an EMR for patient care and population health can't be realized unless practices become proficient, [7] and studies indicate that practices approaching EMR implementation as a complex change management project will realize the greatest benefit. [3] Even in terms of practice management, supports such as workflow optimization are necessary to help a practice realize the full benefit of their EMR.…”

“…[3] [4] [5] [6] However, the benefits of an EMR for patient care and population health can't be realized unless practices become proficient, [7] and studies indicate that practices approaching EMR implementation as a complex change management project will realize the greatest benefit. [3] Even in terms of practice management, supports such as workflow optimization are necessary to help a practice realize the full benefit of their EMR. [8] In the province of Ontario, where 78% of primary care physicians have reportedly adopted EMRs, [1] communitybased physicians using a certified EMR have access to OntarioMD's EMR Practice Enhancement Program (EPEP).…”

Imputing HIV treatment start dates from routine laboratory data in South Africa: a validation study

“…Where patient records are hand-written, implementation and maintenance of electronic records can be expensive and still not impervious to error [2–4]. Accurate clinical record keeping is increasingly important to clinical care and appropriate monitoring and evaluation in such settings [5].…”