Appl Clin Inform. 2013 Jan 16;4(1):12-24. doi: 10.4338/ACI-2012-09-RA-0033. Print 2013.
The federal government is promoting adoption of electronic health records (EHRs) through financial incentives for EHR use and implementation support provided by regional extension centers. Small practices have been slow to adopt EHRs.
Our objective was to measure time to EHR implementation and identify factors associated with successful implementation in small practices receiving financial incentives and implementation support. This study is unique in exploiting quantitative implementation time data collected prospectively as part of routine project management.
This mixed-methods study includes interviews of key informants and a cohort study of 544 practices that had worked with the Primary Care Information Project (PCIP), a publicly funded organization that since 2007 has subsidized EHRs and provided implementation support similar to that supplied by the new regional extension centers. Data from a project management database were used for a cohort study to assess time to implementation and predictors of implementation success.
Four hundred and thirty practices (79%) implemented EHRs within the analysis period, with a median project time of 24.7 weeks (95% CI: 23.3 - 26.4). Factors associated with implementation success were: fewer providers, practice sites, and patients; fewer Medicaid and uninsured patients; having previous experience with scheduling software; enrolling in 2010 rather than earlier; and selecting an integrated EHR plus practice management product rather than two products. Interviews identified positive attitude toward EHRs, resources, and centralized leadership as additional practice-level predictors of success.
A local initiative similar to current federal programs successfully implemented EHRs in primary care practices by offsetting software costs and providing implementation assistance. Nevertheless, implementation success was affected by practice size and other characteristics, suggesting that the federal programs can reduce barriers to EHR implementation but may not eliminate them.
联邦政府通过为电子健康记录 (EHR) 的使用提供财政激励，并通过区域扩展中心提供实施支持，来推动 EHR 的采用。小医疗机构采用 EHR 的速度较慢。
我们的目的是衡量 EHR 实施的时间，并确定在接受财政激励和实施支持的小型医疗机构中，与成功实施相关的因素。这项研究的独特之处在于利用了作为常规项目管理的一部分前瞻性收集的定量实施时间数据。
这项混合方法研究包括对主要信息提供者的访谈以及对 544 家已经与初级保健信息项目 (PCIP) 合作的诊所的队列研究。PCIP 是一个公共资助的组织，自 2007 年以来，它一直在补贴 EHR 并提供类似于新的区域扩展中心提供的实施支持。项目管理数据库中的数据用于队列研究，以评估实施时间和实施成功的预测因素。
在分析期内，有 430 家（79%）实践实现了 EHR，项目时间中位数为 24.7 周（95% CI：23.3-26.4）。与实施成功相关的因素包括：提供者、实践地点和患者较少； Medicaid 和无保险患者较少；有先前使用日程安排软件的经验；2010 年注册，而不是更早；选择集成 EHR 加实践管理产品，而不是两个产品。访谈确定了对 EHR 的积极态度、资源和集中化领导是成功的额外实践水平预测因素。
一个类似于当前联邦计划的本地计划通过抵消软件成本和提供实施帮助，成功地在初级保健实践中实施了 EHR。然而，实施成功受到实践规模和其他特征的影响，这表明联邦计划可以减少 EHR 实施的障碍，但可能无法消除这些障碍。
