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

项目总结 HITECH法案制定了一种广泛而雄心勃勃的方法，鼓励提供商 采用和使用健康信息技术，以期提高质量、安全和 护理的效率。核心内容是为实施以下服务的提供商提供财务激励 电子健康记录(EHR)，并根据联邦规定使用它们 有意义的使用标准。重点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)，使患者的健康信息能够在不同的交付设置之间跟踪他们。 护理协调标准侧重于汇总护理记录交换和对账 药物、药物过敏和问题。然而，这些标准很大程度上 推迟到有意义的使用的后期阶段，因为它们构成了独特的挑战： 提供商需要学习如何使用EHR来生成关键的信息片段 应在不同的环境中跟踪患者；(2)提供者需要有能力参与 HIE；以及(3)提供商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临床数据，限制了我们对 如何确保国家对卫生信息技术的投资带来更协调的医疗保健。 我们的项目是响应特别强调通知NOT-HS-13-006而开发的，将 提供证据证明当前已准备好满足拟议的第三阶段护理协调 初级保健实践的标准，并考虑到我们发现的差距，确定潜在的 实现标准实现的障碍和促进者。我们的项目还将评估 标准的实现是否改善了护理协调，并确定了实践主导和 政策驱动的战略，增加电子病历使用的程度，从而产生良好的 协调护理。为了达到这些目标，我们将进行一项混合方法的研究， 包括(1)密歇根州初级保健实践的全州调查，证明 第一阶段有意义的使用，辅之以(2)定性和定量分析 实施阶段3护理协调措施的经验，以及 在15个初级保健实践中，对护理协调的影响。我们的发现将有助于确保 最后阶段3护理协调标准是以证据为基础的，设定的目标是 两者都是可以实现的，并且都带来了实质性的收益。他们还将指导实践中的最佳 使用电子病历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.