Assessing Readiness, Achievement & Impact of Stage 3 Care Coordination Criteria

项目摘要 HITECH法案制定了一个广泛而雄心勃勃的方法，鼓励供应商 采用和使用卫生信息技术的方式，预计将提高质量，安全和 护理效率。其核心是对实施这些措施的供应商的经济激励。 电子健康记录（EHR），并按照联邦规定使用它们 有意义的使用标准。大力强调促进护理协调的标准 由于电子健康记录的潜力，加上电子健康信息交换， (HIE)，以使患者的健康信息能够在分娩设置之间跟随他们。 护理协调标准侧重于简要护理记录交换和 药物，药物过敏，和问题。然而，这些标准主要 推迟到有意义使用的后期阶段，因为它们带来了独特的挑战： 提供者需要学习如何使用EHR生成关键信息， 应在不同环境之间跟踪患者;（2）提供者需要能够参与 HIE;以及（3）提供者需要习惯于接收和合并数据 从其他环境到临床决策。大多数供应商几乎没有经验 交换或使用电子共享的临床数据，限制了我们对 如何确保国家在卫生信息技术方面的投资能够带来更加协调的护理。 我们的项目是根据特别强调通知NOT-HS-13-006开发的， 生成当前准备就绪的证据，以满足拟议的第3阶段护理协调 标准在初级保健的做法，并鉴于我们发现的差距，确定潜在的 实现标准的障碍和促进因素。我们的项目还将评估 标准的实现是否改善了护理协调，并确定以实践为导向的， 政策驱动的战略，提高EHR使用的程度， 协调护理。为了实现这些目标，我们将进行一项混合方法研究， 包括（1）密歇根州全州范围内的初级保健实践调查， 阶段1有意义的使用，辅以（2）定性和定量分析 实施第三阶段护理协调措施的经验，并认为 对15个初级保健实践中护理协调的影响。我们的发现将有助于确保 最终的第3阶段护理协调标准是以证据为基础的，并设定了 两者都是可以实现的，并会带来巨大的收益。他们还将指导实践， 使用EHR改善护理协调的策略。

PROJECT SUMMARY The HITECH Act laid out a broad and ambitious approach to encourage providers to adopt and use health IT in ways that are expected to improve the quality, safety and efficiency of care. The centerpiece is financial incentives for providers who implement electronic health records (EHRs) and use them in accordance with federally specified meaningful use criteria. Criteria that promote care coordination are heavily emphasized because of the potential for EHRs, coupled with electronic health information exchange (HIE), to enable patients' health information to follow them between delivery settings. Care coordination criteria focus on summary care record exchange and reconciliation of medications, medication allergies, and problems. These criteria were, however, largely deferred to later stages of meaningful use because of the unique challenges they pose: providers need to learn how to use EHRs to generate key pieces of information that should follow patients between settings; (2) providers need the capability to engage in HIE; and (3) providers need to become accustomed to receiving and incorporating data from other settings into clinical decisions. Most providers have little experience exchanging or using electronically shared clinical data, limiting our understanding of how to ensure that the national investment in health IT results in more coordinated care. Our project, developed in response to Special Emphasis Notice NOT-HS-13-006, will generate evidence on current readiness to meet proposed Stage 3 care coordination criteria in primary care practices and, given the gaps we find, identify the underlying barriers and facilitators that enable criteria achievement. Our project will also assess whether criteria achievement improves care coordination, and identify practice-led and policy-driven strategies that increase the extent to which EHR use results in well- coordinated care. To achieve these aims, we will conduct a mixed-methods study that includes (1) a statewide survey of primary care practices in Michigan that have attested to Stage 1 meaningful use, complemented by (2) qualitative and quantitative analyses of the experience implementing Stage 3 care coordination measures, and perceived impact on care coordination, in 15 primary care practices. Our findings will help ensure that final Stage 3 care coordination criteria are evidence-based, and set targets that are both achievable and result in substantial gains. They will also guide practices on optimal strategies for using EHRs to improve care coordination.