Impact of Health IT on Primary Care Work-flow and Financial Measures

描述(由申请人提供)：HealthTexas Provider Network(HTPN)是德克萨斯州北部的一个大型非卧床医疗网络，它正在实施动态电子健康记录(AEHR)，以提高医疗质量、安全性、有效性和效率。拟议的研究将评估AEHR实施对工作流程和财务成果衡量标准的影响，有助于了解AEHR采用AEHR的常见障碍、实施过程中对生产率和财务业绩影响的不确定性，以及支持AEHR在初级保健环境中实施和维护所需的不确定财务和非财务成本。因此，该项目涉及采用卫生信息技术(IT)以通过使用综合数据和知识管理改进卫生保健决策的决策的重要方面。HTPN正在部署商业上可用的AEHR(GE Centricity医生办公室-EMR 2005)，实践证明是错开的，从2006年年中开始，持续了大约3.5年。我们将使用AEHR实施前和实施后的账单和行政数据来检查对工作流程和财务结果的影响。目的1：评估AEHR对工作流程结果测量的影响。我们将检查AEHR的实施对每个医生全职当量(FTE)的非医生工作人员、每个医生FTE的工作相对价值单位(RVU)、每次就诊的工作RVU和每个医生FTE的访问次数的影响；还将测试AEHR随着时间的推移对这些指标产生不同影响的可能性。目的2：评估AEHR对财务指标的影响。我们将研究AEHR实施对每个工作RVU的执业费用、每个总RVU的实践费用、每个工作RVU收到的报酬、每个医生的净收入FTE和每个工作的RVU的净收入的影响； 测试AEHR随着时间的推移对这些措施产生不同影响的可能性。目标3：量化卫生信息技术实施和维护的财务和非财务成本，提供有关AEHR采用和实施的感知障碍和促进者的知识。我们将量化与AEHR相关的硬件、软件和系统资源采购的财务成本；HTPN AEHR团队在每个诊所部署期间的时间和精力；与执业医生冠军和办公室经理监督AEHR实施任务(例如规划、工作流程重组和培训)相关的非财务成本；以及医生、护士和办公室工作人员准备使用AEHR所花费的时间(例如预加载图表、培训)；以及财务和非财务维护成本(例如许可证、HTPN公司人员、技术支持)。我们将通过应用薪资中的薪资信息来量化非财务/机会成本 医生、护士和办公室工作人员级别的数据。这项研究将为现实世界的卫生信息技术采用和实施决策提供信息，让利益相关者，特别是那些沿着创新决策过程连续体的利益相关者；并通过增加关于门诊护理环境中卫生信息技术实施的感知障碍的知识库，刺激更全面的卫生信息技术实施研究。

DESCRIPTION (provided by the applicant): HealthTexas Provider Network (HTPN), a large, ambulatory care network in North Texas, is implementing an ambulatory electronic health record (AEHR) to improve the quality, safety, effectiveness, and efficiency of care. The proposed study will evaluate impact of the AEHR implementation on workflow and financial outcome measures, contributing knowledge about the frequently cited perceived barriers to AEHR adoption of uncertainty regarding impact on productivity and financial performance during implementation, and uncertain financial and non-financial costs required to support AEHR implementation and maintenance in primary care settings. This project thus addresses important aspects of decisions to adopt Health Information Technology (IT) to improve health care decision-making through the use of integrated data and knowledge management. HTPN is deploying a commercially available AEHR (GE Centricity Physician Office -EMR 2005), staggered by practice, over ~3.5 years beginning mid-2006. We will use pre- and post-AEHR implementation billing and administrative data to examine impact on workflow and financial outcomes. Aim 1: To estimate the effect of the AEHR on workflow outcome measures. We will examine impact of the AEHR implementation on Non-physician Staff per Physician Full Time Equivalent (FTE), Work Relative Value Units (RVUs) per Physician FTE, Work RVU per Visit, and Visits per Physician FTE; also testing for the possibility the AEHR has differential impacts on these measures over time. Aim 2: To estimate the effect of the AEHR on financial measures. We will examine impact of the AEHR implementation on Practice Expense per Work RVU, Practice Expense per Total RVU, Payment Received per Work RVU, Net Income per Physician FTE, and Net Income per Work RVU; also testing for the possibility the AEHR has differential impacts on these measures over time. Aim 3: To quantify financial and non-financial costs of Health IT implementation and maintenance, contributing knowledge about perceived barriers and facilitators to AEHR adoption and implementation. We will quantify the financial costs of AEHR-related purchases of hardware, software, and system resources; time and effort of the HTPN AEHR Team during deployment at each practice; non-financial costs related to practice physician champions' and office managers' time spent overseeing AEHR implementation tasks (e.g., planning, workflow reengineering, and training); and time spent by physicians, nurses, and office staff preparing for AEHR use (e.g. pre-loading charts, training); and financial and non-financial maintenance costs (e.g., licensing, HTPN corporate personnel, technical support). We will quantify non-financial/opportunity costs by applying salary information from payroll data at the physician, nurse, and office staff levels. This study will inform real world health IT adoption and implementation decisions for stakeholders, especially those along the innovation decision process continuum; and stimulate more comprehensive health IT implementation research by increasing the knowledge-base regarding perceived barriers to health IT implementation in ambulatory care settings.