Impact of Core Electronic Health Record Functionalities on Cardiovascular Disease Preventive Health Services for Underserved Patients

Abstract

Objectives: Examine differences in the associations between core Electronic Health Record (EHR) functionalities for public and population health, care coordination, patient engagement, and quality improvement on the provision of recommended Cardiovascular Disease (CVD) preventive health services provided at Primary Care Visits (PCVs) for CVD at-risk adults with Medicaid and those with private insurance. Methods: Utilizing a nationally representative survey of ambulatory care visits by patients at risk for CVD in 2014 and 2015, binary logistic regression models examined the associations between core EHR functionalities and the provision of recommended CVD preventive services for Medicaid and private insurance patients at risk for CVD, controlling for patient and provider confounding variables. Results: Primary care providers caring for Medicaid patients were significantly less likely to adopt fully functional certified EHR technology compared to PCPs caring for private insurance patients (75% vs. 82%, p < 0.01). Medicaid patients were significantly less likely to receive recommended blood pressure screening compared to private insurance patients (95% CI, 0.205-0.931). Among preventive visits for Medicaid patients at risk for CVD, significant associations were found between select recommended CVD preventive services and public and population health management, care coordination, and patient engagement. Discussion: Mixed results were found between core EHR functionalities and the provision of recommended CVD preventive services provided at PCVs for Medicaid patients. Low physician adoption of fully functional certified EHR technology may have impacted the provision of recommended CVD preventive services for Medicaid patients. Conclusion: Study findings demonstrate concerns about the rates of recommended CVD preventive services at PCVs for Medicaid patients at risk for CVD, which imply gaps in their care. Further investigation is required to understand how the approved list of electronic clinical quality measures impacts the associations between core EHR functionalities and the provision of recommended CVD preventive services delivered at PCVs.