Health IT-Enabled Care Coordination: A National Survey of Patient-Centered Medical Home Clinicians

Abstract

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...

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“…The inability to transfer clinical information between organizations remains a persistent barrier to care coordination, as evidenced by a recent decrease in the number of operational HIEs [9] and the challenges primary care practices face in using health IT to coordinate emergency and inpatient care [4]. Our findings seem to align with those of a prior qualitative study, in which consumers expressed willingness to make tradeoffs between privacy and security if a mobile health (mHealth) intervention offered increased convenience or benefits [23].…”

“…In many communities, such as large urban areas, care is fragmented across health systems and providers [3,4]. Resulting failures in care coordination can lead to adverse outcomes such as hospital readmissions [5] and wasteful health spending [5,6].…”

“…Electronic health records (EHRs) are often unable to facilitate care coordination between organizations [4,7], and less than half of U.S. hospitals [8] and providers [9] participate in an operational health information exchange (HIE). While interventions that prioritize care coordination-such as disease management and transitional care programs for chronically ill patients-have reduced hospital admissions [10][11][12] or improved patient-reported outcomes [11,12], their replicability and scalability are limited by a lack of global cost-savings [10,13].…”

From programme theory to logic models for multispecialty community providers: a realist evidence synthesis

“…116 Finally, care managers emerged as important facilitators of effective HIT use. Morton et al 120 found that practices with a non-clinician member of staff who was responsible for co-ordinating care were much better at care co-ordinating activities and conducting these activities electronically. Other studies 118 also noted that the care manager provided much-needed support to ensure smooth operations.…”

In This Issue: A Cry for Balance

“…3 In an analysis of response to health care delivery reforms, Sandy et al find that, among practices participating with a large commercial insurer, patientcentered medical home recognition seems to be positively associated with meeting quality benchmarks but negatively associated with efficiency parameters. 4 In their analysis, the authors ask, "Should a physician spend time and energy focusing on structural measures and process changes such as those embodied in NCQA [National Center for Quality Assurance] PCMH recognition?…”