Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO 80045, USA.
J Am Board Fam Med. 2013 Sep-Oct;26(5):603-11. doi: 10.3122/jabfm.2013.05.120344.
The Health Information Technology for Economic and Clinical Health Act of 2009 provides for incentive payments through Medicare and Medicaid for clinicians who implement electronic health records (EHRs) and use this technology meaningfully to improve patient care. There are few comprehensive descriptions of how primary care practices achieve the meaningful use of clinical data, including the formal stage 1 meaningful use requirements.
Evaluation of the Colorado Beacon Consortium project included iterative qualitative analysis of practice narratives, provider and staff interviews, and separate focus groups with quality improvement (QI) advisors and staff from the regional health information exchange (HIE).
Most practices described significant realignment of practice priorities and aims, which often required substantial education and training of physicians and staff. Re-engineering office processes, data collection protocols, EHRs, staff roles, and practice culture comprised the primary effort and commitment to attest to stage 1 meaningful use and subsequent meaningful use of clinical data. While realizing important benefits, practices bore a significant burden in learning the true capabilities of their EHRs with little effective support from vendors. Attestation was an important initial milestone in the process, but practices faced substantial ongoing work to use their data meaningfully for patient care and QI. Key resources were instrumental to these practices: local technical EHR expertise; collaborative learning mechanisms; and regular contact and support from QI advisors.
Meeting the stage 1 requirements for incentives under Medicare and Medicaid meaningful use criteria is the first waypoint in a longer journey by primary care practices to the meaningful use of electronic data to continuously improve the care and health of their patients. The intensive re-engineering effort for stage 1 yielded practice changes consistent with larger practice aims and goals. While many of these practices are now poised to use data meaningfully, faster progress will likely come with continued local QI and technical support and planned community-wide learning.
2009 年的《健康信息技术经济临床健康法案》规定,对于实施电子健康记录(EHR)并利用该技术切实改善患者护理的临床医生,医疗保险和医疗补助计划将提供奖励性付款。关于初级保健实践如何实现临床数据的有意义使用,包括正式的第 1 阶段有意义使用要求,几乎没有全面的描述。
对科罗拉多灯塔联盟项目的评估包括对实践叙述、提供者和工作人员的访谈进行迭代的定性分析,以及与质量改进(QI)顾问和区域健康信息交换(HIE)工作人员进行单独的焦点小组讨论。
大多数实践都描述了对实践重点和目标的重大调整,这通常需要对医生和工作人员进行大量的教育和培训。重新设计办公流程、数据收集协议、EHR、工作人员角色和实践文化构成了主要的努力和承诺,以证明第 1 阶段有意义的使用和随后对临床数据的有意义使用。虽然实现了重要的收益,但实践在学习其 EHR 的真正功能方面承担了巨大的负担,而供应商几乎没有提供有效的支持。证明是该过程中的一个重要的初始里程碑,但实践在使用其数据为患者护理和 QI 提供有意义的服务方面面临着巨大的持续工作。关键资源对这些实践至关重要:本地技术 EHR 专业知识;协作学习机制;以及来自 QI 顾问的定期联系和支持。
满足医疗保险和医疗补助有意义使用标准下的第 1 阶段激励要求是初级保健实践实现电子数据的有意义使用以持续改善患者护理和健康的更长旅程的第一个里程碑。第 1 阶段的密集再造工作产生了与更大实践目标和目标一致的实践变化。虽然许多这些实践现在已经准备好有意义地使用数据,但随着持续的本地 QI 和技术支持以及计划的社区范围的学习,可能会取得更快的进展。