Gray B, Vandergrift J. — American Board of Internal Medicine
McCullough J. — University of Minnesota
Presented: AcademyHealth Annual Research Meeting, June 2015
The Health Information Technology for Economic and Clinical Health (HITECH) Act, implemented in 2011, included an estimated $40 billion to fund the adoption and meaningful use of Electronic Health Record (EHR) technology. The purpose of our study was to examine the degree to which the act met its objectives in terms of not only EHR adoption and meaningful use but also in supporting patient-centered primary care.
Data were used from office-based internists with a primary care focus who completed a practice improvement module (PIM) between 2008 and 2014 as part of the ABIM 10-year Maintenance of Certification (MOC) requirement. These data included a detailed EHR adoption and meaningful use survey that mirrored National Committee for Quality Assurance (NCQA)'s Patient-Centered Medical Home (PCMH) standards. An overall EHR composite score was computed equivalent to the PCMH eligibility standard score, as well as two sub-scores, one focusing on EHR adoption (e.g., e-prescribing, patient registry) and one focusing on care quality (e.g., performance monitoring, providing patient-centered self-care). These scores were regressed against a year trend, a HITECH indicator (one for 2011 and later, zero otherwise), and an interaction between trend and this indicator. The HITECH indicator coefficient measures association with the act’s implementation and changes in the level of a score. The HITECH trend interaction coefficient measures associations with changes in score trends over time. The model controlled for county-level measures (e.g., urbanity and socio-economic status), Health and Human Service region, physician gender and medical school country.
Mid-career office based internists who reported most (>50%) of their clinical time was in office-based primary care (5,752).
Results showed that the HITECH Act was associated with an increase in both the level and trend of the overall PCMH score (3.5 percentage point increase [P<.05], 0.8 percentage point yearly increase [P<.05]. These changes in trend were significantly larger among physicians who operated in small practices (<6 physicians) than large practices (>25 physicians) (4.0 percentage point per year difference [P<.05]. For small practices, findings indicated that the HITECH Act was associated with an increase in the overall PCMH score from 2011 (implementation year) to 2014 (end of the study period) of 14 points or over half the minimum qualification for PCMH status.
Results also indicated that the HITECH act was associated with an almost immediate increase in the EHR adoption sub-score (4.6 percentage points, [P<.001] and both an immediate and more gradual increase in the care quality sub-score (2.7 percentage point level increase and 2.0 percentage point yearly increase, Ps<.05).
Overall, this study provided evidence that the HITECH Act was associated with policy significant increases in EHR adoption and meaningful use as well as patient-centered care for office-based primary care physicians and that this association was largest for small practices.
Implications for Policy or Practice:
A key implication of our finding is that the HITECH Act supported EHR adoption and meaningful use and, perhaps more importantly, patient-centered care. Another important implication is that these effects were concentrated in smaller practices where the need for this support is greatest.
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