Statewide Implementation of Electronic Health Records

描述（由申请人提供）：电子健康记录 (EHR) 是提高医疗保健安全和质量的重要工具，但大多数诊所医生目前不使用该技术。在马萨诸塞州，一些大型医疗服务提供者组织使用最先进的电子病历，但大多数单独或小组执业的医生仍然依赖纸质记录。全州范围内的多利益相关者联盟已启动一项单独资助的计划，以促进马萨诸塞州所有医生办公室采用电子病历，并开发互连基础设施，以实现全州健康信息的交换。该干预计划涉及为采用电子病历的医生建立经济激励制度，是马萨诸塞州的医疗服务提供者、保险公司和企业与州政府合作的共同努力。 该申请建议对这一全州实施计划对马萨诸塞州农村和非农村流动护理实践采用 EHR 的影响进行严格评估。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、更快速地采用电子病历？ 2) 采用电子病历可以在多大程度上减少用药错误并提高门诊医疗保健的质量？ 3) 医生对 EHR 的接受程度和使用有何相关性？ 4) 强化教育推广计划（“学术细节”）是否会比标准 EHR 实施计划更有效地促进 EHR 的采用并最大限度地减少医生生产力的损失？这些问题将通过对该州所有办公室实践的调查（N 约为 6,000）、10 个初级保健实践中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 名医生的分层随机样本的调查以及对总共 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。 该计划评估将提供有关激励计划和教育推广作用的急需信息，以促进 EHR 和相关 HIT 在全国社区的采用。这项工作成果的传播应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.