Jones Emily, Wittie Michael
From the Division of Behavioral Health and Intellectual Disabilities Policy, Office of Disability, Aging, and Long-Term Care Policy, Office of the Assistant Secretary for Planning and Evaluation, US Department of Health and Human Services, Washington, DC (EJ); Department of Health Policy and Management, The Milken Institute School of Public Health and Health Services, The George Washington University, Washington, DC (EJ); the Office of Clinical Safety and Quality, Office of the National Coordinator for Health Information Technology, US Department of Health and Human Services, Washington, DC (MW).
J Am Board Fam Med. 2015 Sep-Oct;28(5):565-75. doi: 10.3122/jabfm.2015.05.150034.
To complement national and state-level HITECH Act programs, 17 Beacon communities were funded to fuel community-wide use of health information technology to improve quality. Health centers in Beacon communities received supplemental funding.
This article explores the association between participation in the Beacon program and the adoption of electronic health records. Using the 2010-2012 Uniform Data System, trends in health information technology adoption among health centers located within and outside of Beacon communities were explored using differences in mean t tests and multivariate logistic regression.
Electronic health record adoption was widespread and rapidly growing in all health centers, especially quality improvement functionalities: structured data capture, order and results management, and clinical decision support. Adoption lagged for functionalities supporting patient engagement, performance measurement, care coordination, and public health. The use of advanced functionalities such as care coordination grew faster in Beacon health centers, and Beacon health centers had 1.7 times higher odds of adopting health records with basic safety and quality functionalities in 2010-2012.
Three factors likely underlie these findings: technical assistance, community-wide activation supporting health information exchange, and the layering of financial incentives. Additional technical assistance and community-wide activation is needed to support the use of functionalities that are currently lagging.
为补充国家和州层面的《健康信息技术经济和临床健康法案》（HITECH Act）项目，17个灯塔社区获得资助，以推动社区范围内健康信息技术的使用，从而提高医疗质量。灯塔社区的健康中心获得了补充资金。
本文探讨了参与灯塔项目与采用电子健康记录之间的关联。利用2010 - 2012年统一数据系统，通过均值t检验和多元逻辑回归分析差异，研究了灯塔社区内外健康中心在健康信息技术采用方面的趋势。
电子健康记录的采用在所有健康中心都很普遍且迅速增长，尤其是质量改进功能：结构化数据捕获、医嘱和结果管理以及临床决策支持。支持患者参与、绩效评估、护理协调和公共卫生的功能采用滞后。在灯塔健康中心，诸如护理协调等高级功能的使用增长更快，并且在2010 - 2012年，灯塔健康中心采用具备基本安全和质量功能的健康记录的几率高出1.7倍。
这些发现可能基于三个因素：技术援助、支持健康信息交换的社区层面动员以及财政激励的叠加。需要额外的技术援助和社区层面的动员来支持目前滞后的功能的使用。
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