Health Affairs: Mass. program could be U.S. model
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In particular, the program promoted greater use of patient registries, according to the research, published in the July edition of Health Affairs. The authors suggested physicians participating in the Massachusetts eHealth Collaborative who are frequest users of EHRs are more likely to use registries—particularly in caring for patients with diabetes—than less-avid EHR users.
“We knew physicians were generating registries for their own purposes prior to EHRs,” said lead author Marshall Fleurant, general internal medicine research fellow in the department of population medicine at Harvard Health Care Institute and Harvard Medical School in Boston, in an interview. “We wanted to see if this EHR project increased registry use over time because we felt this program may have the potential to increase the physician’s capacity to look at their own quality measures.”
Using the ability to generate registries as a proxy to evaluate their quality, the researchers evaluated the implementation of EHRs using pre- and post-intervention surveys to measure physicians’ perceived ability to generate registries. A total of 163 physicians from 134 practices completed both the 2005 and 2009 survey instruments.
Compared with all survey respondents in 2005, all respondents in 2009 were more likely to be able to generate each registry type, the authors found. “Among the 163 physicians who completed both surveys, the ability to generate a diagnosis registry was similar over the study period (88 percent in 2009; 89 percent in 2005). In contrast, 78 percent of these physicians in 2009 were able to generate a laboratory results registry, compared with 44 percent in 2005; and 83 percent in 2009 could generate a medication registry, compared with 33 percent in 2005.”
Physicians in 2009 were more likely to be able to generate a laboratory and a medication registry than they were in 2005 when the researchers adjusted for all available covariates.
According to Fleurant, in a secondary analysis that looked at the association in frequency of EHR use and registry tasks performed by physicians, there “seemed to be a trend that physicians who use more features of an EHR are more likely to use registries particularly in the care of patients with diabetes.”
“We did not find this association was the same in the care of patients with coronary artery disease,” Fleurant continued. "What we learned is that an organized, collaborative, community-based method for EHR implementation could be a viable model for the widespread EHR implementation across the country. Giving physicians the ability to generate these registries could be a form to measure quality in their own registries.”
The study had some limitations, the researchers noted. The biggest of these was the lack of a control group. “It is possible that a trend toward increased attention to quality measurement and improvement during the study period, including interest in pay-for-performance initiatives, might have included registry capabilities,” the authors wrote. “Our unpublished statewide data do …suggest a noncyclical trend toward increased registry capability. However, the magnitude of the pre-post intervention effect observed in this study seems too great to be accounted for by this secular trend alone.”
Another limitation Fleurant noted was that the survey didn’t look into the registries’ abilities. “There are unique differences between registries [and] we have to learn how physicians are using these registries, particularly specialty registries,” he said.
Practice size was significantly associated with the ability to generate all registry types: Smaller practices were consistently less likely than larger practices to be able to generate registries. “The observation that 89 percent of practices at baseline were able to generate registries deserves further mention,” the authors wrote. “More than 70 percent of large physician organizations can generate diagnosis registries. However, little is known about small and medium-size practices, such as those in our study.”
According to Fleurant, the study was important in that it highlighted MeHC’s success in bringing multiple stakeholders together to reach one goal.
“In terms of policy, now that the federal government has in place programs like the Beacon Communities and regional extension centers, this would be a good opportunity for regulatory agencies to look into programs like the Massachusetts eHealth Collaborative when looking at broader approaches in EHR implementation projects,” Fleurant concluded.