Small practices need help to improve outcomes with EHRs

Unless they can get a lot of technical assistance, small physician practices may have a hard time achieving better health outcomes for their patients with their EHRs, according to research published in the January issue of Health Affairs.

“Despite the enthusiasm for EHRs, and the recent acceleration in their adoption, evidence that they improve the quality of care is mixed,” wrote lead author Andrew M. Ryan, PhD, an assistant professor of public health and of medicine at Weill Cornell Medical College in New York City, and colleagues. “They may have long-term benefits, but the transition from paper to electronic records can be disruptive, with a steep learning curve required to use the features of the EHR effectively to improve the quality of care.”

To determine the impact of EHR adoption specifically in small primary care practices, researchers looked to the New York City Primary Care Information Project (PCIP), which was launched in 2005 to subsidize the cost of EHR implementation for primary care providers treating Medicaid and uninsured patients. Beginning in 2007, PCIP began offering technical assistance to participating providers and, in 2011, the project become one of 60 nationwide regional extension centers (RECs).

Using data from the New York Quality Alliance, which includes quality measures based on the healthcare effectiveness data and information set, researchers assessed the quality of care provided by 360 providers participating in PCIP. As a whole, providers, even those receiving multiple technical assistance visits, were generally unable to demonstrate an improvement in quality of care provided within two years of EHR adoption. However, providers receiving multiple technical assistance visits were more likely to perform better against some measures, including breast screening for women and urine testing for patients with diabetes.

Based on their results, researchers concluded that sustained technical assistance, such as that provided by RECs, had an important role to play in facilitating improvements in care quality and that it will take time to realize benefits against medium- and longer-term outcomes.

“Improvements were small, were for only a limited number of measures and did not until at least nine months of using the EHR,” Ryan et al wrote. “These findings suggest that small practices in disadvantaged areas may need considerable help to use EHRs to improve quality.”