Statewide Implementation of Electronic Health Records

描述(由申请人提供)：电子健康记录(EHR)是改善医疗保健安全和质量的重要工具，但大多数办公室医生目前并不使用这项技术。在马萨诸塞州，几个大型医疗服务提供者组织使用最先进的电子病历，但大多数单独执业或以小组形式执业的医生仍然依赖纸质记录。一个全州范围的多方利益相关者联盟已经启动了一个单独资助的计划，以促进在马萨诸塞州所有医生的办公室采用EHR，并开发互联基础设施，以实现全州范围内的健康信息交换。这项干预计划涉及为采用EHR的医生建立财务激励制度，是马萨诸塞州供应商、保险公司和企业与州政府合作的努力。 这项申请提出了一个严格的评估这一全州范围的实施计划对马萨诸塞州农村和非农村门诊护理实践采用电子病历的影响。本研究将解决以下问题：1)与“自然”采用率相比，基于激励的协作干预计划是否会促进更广泛和更快速地采用电子健康记录？2)电子健康记录的采用将在多大程度上减少用药差错并提高门诊医疗保健的质量？3)医生接受程度与电子健康记录的使用有什么关系？4)密集的教育外展计划(“学术细节”)是否会比标准的电子健康记录实施计划更有效地促进电子健康记录的采用并将医生生产力的损失降至最低？这些问题将通过对该州所有办公室实践(N约为6,000)的调查、对10个初级保健实践中的用药错误的比较分析、全州范围的实践质量数据分析(包括HEDIS措施)、对2,000名医生的分层随机抽样的调查，以及对总共30个农村和非农村实践的学术详细干预的随机对照试验来解决。 这项计划评估将提供关于激励计划和教育推广的作用的急需信息，以促进在全国社区采用EHR和相关的HIT。这项工作成果的传播将加快建立国家卫生信息基础设施的努力。

DESCRIPTION (provided by the applicant): Electronic health records (EHRs) represent an essential tool for improving the safety and quality of health care, but most physicians in office practices do not currently use this technology. In Massachusetts, several large provider organizations utilize state-of-the art EHRs, but most physicians practicing solo or in small groups continue to rely on paper records. A statewide multi-stakeholder coalition has embarked on a separately funded program to facilitate the adoption of EHRs in the offices of all physicians throughout Massachusetts and to develop the interconnectivity infrastructure to enable the exchange of health information across the state. The intervention program, which involves establishing a system of financial incentives for physicians that adopt EHRs, is a collaborative effort among providers, insurers, and businesses in Massachusetts, in cooperation with the State government. This application proposes a rigorous evaluation of the impact of this statewide implementation program on EHR adoption by rural and non-rural ambulatory care practices in Massachusetts. This study will address the following questions: 1) Will an incentive-based collaborative intervention program facilitate more extensive and more rapid adoption of EHRs as compared with the "natural" rate of adoption? 2) To what extent will adoption of EHRs reduce medication errors and improve the quality of ambulatory health care? 3) What are the correlates of physician receptivity and use of EHRs? 4) Will an intensive program of educational outreach ("academic detailing") more effectively foster the adoption of EHRs and minimize the loss of physician productivity than standard EHR implementation programs? These questions will be addressed by a survey of all office practices in the state (N is approximately 6,000), comparative analysis of medication errors in 10 primary care practices, statewide practice quality data analysis (including HEDIS measures), survey to a stratified random sample of 2,000 physicians, and a randomized controlled trial of an academic detailing intervention in a total of 30 rural and non-rural practices. This program evaluation will provide much-needed information on the role of incentive programs and of educational outreach to facilitate the adoption of EHRs and related HIT in communities nationwide. Dissemination of the results of this work should speed efforts toward the establishment of a national health information infrastructure.