Statewide Implementation of Electronic Health Records

描述（由申请人提供）：电子健康记录（EHRs）是提高医疗保健安全和质量的重要工具，但大多数医生在办公室实践中目前并未使用这项技术。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。一个全州范围内的多方利益相关者联盟已经启动了一个单独资助的项目，以促进马萨诸塞州所有医生办公室采用电子病历，并开发互联基础设施，使全州的健康信息交换成为可能。干预项目包括为采用电子病历的医生建立一个财政激励系统，是马萨诸塞州医疗服务提供者、保险公司和企业与州政府合作的成果。

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.