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性和质量的重要工具，但目前大多数诊所医生都没有使用这项技术。在马萨诸塞州，几家大型医疗机构使用最先进的电子病历，但大多数单独执业或小团体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开始实施一项单独资助的计划，以促进马萨诸塞州所有医生的办公室采用EHR，并开发互连基础设施，以实现全州的健康信息交换。干预计划涉及为采用EHR的医生建立一个经济激励系统，是马萨诸塞州的供应商、保险公司和企业与州政府合作的一项合作努力。 本申请提出了一个严格的评估的影响，这个全州范围内的实施计划，通过电子健康记录的农村和非农村门诊护理实践在马萨诸塞州。本研究将探讨以下问题：1）与“自然”采用率相比，以激励为基础的合作干预计划是否会促进更广泛和更迅速的采用EHR？2)电子健康记录的采用在多大程度上会减少用药错误并提高门诊医疗服务的质量？3)医生的接受度和电子病历的使用有什么相关性？4)与标准的EHR实施方案相比，密集的教育推广方案（“学术细节”）是否能更有效地促进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做法的调查来解决（N约为6，000），10个初级保健实践中用药错误的比较分析，全州实践质量数据分析（包括HEDIS测量），对2,000名医生的分层随机样本进行调查，以及一项随机对照试验，对总共30个农村和非农村实践进行了详细的学术干预。 这项计划的评估将提供急需的信息，激励计划和教育推广的作用，以促进通过EHR和相关的HIT在全国各地的社区。传播这项工作的成果应能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.