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

描述（由申请人提供）：德克萨斯州医疗服务提供者网络（HTPN）是北德克萨斯州的一个大型门诊医疗网络，正在实施门诊电子健康记录（AEHR），以提高护理的质量、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结果指标的影响，提供关于在实施过程中对生产力和财务绩效影响的不确定性以及支持AEHR实施和维护所需的不确定的财务和非财务成本的知识，这些通常被认为是采用AEHR的障碍。因此，本项目涉及采用卫生信息技术通过使用综合数据和知识管理改进卫生保健决策的重要方面。HTPN正在部署商用AEHR (GE Centricity Physician Office -EMR 2005)，从2006年年中开始，将耗时3.5年。我们将使用aehr实施前后的计费和管理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实施对非医师员工每名医师全职当量（FTE）、每名医师FTE的工作相对价值单位（RVUs）、每次就诊的工作相对价值单位（RVU）和每名医师FTE的访问量的影响；也测试了随着时间的推移，AEHR对这些指标有不同影响的可能性。目的2：评估AEHR对财务措施的影响。我们将检查AEHR实施对每个工作RVU的执业费用、每个总RVU的执业费用、每个工作RVU的支付收入、每个医生FTE的净收入和每个工作RVU的净收入的影响；也

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.