The regional extension center program: helping physicians meaningfully use health information technology.

Many physicians face financial and organizational barriers that inhibit their adoption of electronic health record (EHR) systems. The 2009 Health Information Technology for Economic and Clinical Health Act included provisions to facilitate the transition from paper to electronic records, including Medicare and Medicaid incentive payments to support the adoption and meaningful use of EHR systems. It also created the Health Information Technology Regional Extension Center (REC) program to ease the barriers faced by primary care physicians and rural and critical-access hospitals seeking to implement EHRs. The 60 RECs will administer individualized assistance to primary care practices and rural and critical-access hospitals as they implement new EHR systems or upgrade existing ones. In aggregate, the RECs aim to help 100 000 primary care physicians, physician assistants, and nurse practitioners to effectively implement EHR systems and qualify for incentive payments for meaningful use. This article describes the rationale for the REC program and describes how the 60 RECs promote the meaningful use of EHR systems.

Medicare Annual Wellness Visit association with healthcare quality and costs.

OBJECTIVES: Although use of the Medicare Annual Wellness Visit (AWV) is increasing nationally, it remains unclear whether it can help contain healthcare costs and improve quality. In the context of 2 primary care physician-led accountable care organizations (ACOs), we tested the hypothesis that AWVs can improve healthcare costs and clinical quality. STUDY DESIGN: A retrospective cohort study using propensity score matching and quasi-experimental difference-in-differences regression models comparing the differential changes in cost, emergency department (ED) visits, and hospitalizations for those who received an AWV versus those who did not from before until after the AWV. Logistic regressions were used for quality measures. METHODS: Between 2014 and 2016, we examined the association of an AWV with healthcare costs, ED visits, hospitalizations, and clinical quality measures. The sample included Medicare beneficiaries attributed to providers across 44 primary care clinics participating in 2 ACOs. RESULTS: Among 8917 Medicare beneficiaries, an AWV was associated with significantly reduced spending on hospital acute care and outpatient services. Patients who received an AWV in the index month experienced a 5.7% reduction in adjusted total healthcare costs over the ensuing 11 months, with the greatest effect seen for patients in the highest hierarchical condition category risk quartile. AWVs were not associated with ED visits or hospitalizations. Beneficiaries who had an AWV were also more likely to receive recommended preventive clinical services. CONCLUSIONS: In a setting that prioritizes care coordination and utilization management, AWVs have the potential to improve healthcare quality and reduce cost.

Using electronic prescribing transaction data to estimate electronic health record adoption.

OBJECTIVE: To determine whether electronic prescribing transaction data can be used to accurately and efficiently track national and regional electronic health record (EHR) adoption in order to evaluate progress toward national goals and identify and address regional disparities. STUDY DESIGN: This study compared national EHR use estimates derived from Surescripts electronic prescribing data for 2007 and 2008 with contemporary National Ambulatory Medical Care Survey (NAMCS) estimates. METHODS: The ratio of relative risks was adapted to test the statistical significance of the difference in the differences between Surescripts and NAMCS estimates in 2007 and 2008. RESULTS: In 2007, the relative ratio (RR) of NAMCS to Surescripts data was 3.73 (95% confidence interval [CI] = 3.27, 4.26). In 2008, the RR was 2.06 (95% CI = 1.75, 2.42). The ratio of RRs for 2007 compared with 2008 was 1.81 (P <.0001), suggesting that Surescripts transactional data for providers prescribing through an EHR is becoming better aligned with accepted measures of EHR adoption in the United States with time. Surescripts-derived state estimates for EHR use ranged from less than 8% (North Dakota, New Jersey, New Mexico) to more than 37% (Minnesota, Wisconsin, Massachusetts, Iowa). CONCLUSIONS: Surescripts transactional data may allow for the ongoing identification of regional trends and assist policy makers in identifying and mitigating emerging disparities in EHR adoption. Further analysis is needed to ensure that Surescripts data continue to correlate with NAMCS results for 2009-2010.

Beacon communities aim to use health information technology to transform the delivery of care.

The Beacon Community Program, authorized under the 2009 American Recovery and Reinvestment Act (ARRA), aims to demonstrate the potential for health information technology to enable local improvements in health care quality, cost efficiency, and population health. If successful, these communitywide efforts will yield important lessons that will assist other communities seeking to harness technology to achieve and sustain health care improvements. This paper highlights key programmatic details that reflect the meaningful use of technology in the fifteen Beacon communities. It describes the innovations they propose and provides insight into current and future challenges.