Soderberg Karen, Rajamani Sripriya, Wholey Douglas, LaVenture Martin
Office of Health Information Technology, Minnesota Department of Health, St. Paul, Minnesota.
Public Health Informatics Program, School of Public Health, University of Minnesota, Minneapolis, Minnesota.
Online J Public Health Inform. 2016 Dec 28;8(3):e204. doi: 10.5210/ojphi.v8i3.7094. eCollection 2016.
Minnesota enacted legislation in 2007 that requires all health care providers in the state to implement an interoperable electronic health record (EHR) system by 2015. 100% of hospitals and 98% of clinics had adopted EHR systems by end of 2015. Minnesota's 2008 health reform included a health care home (HCH) program, Minnesota's patient centered medical home. By end of 2014, 43% of HCH eligible clinics were certified with 335 certified HCHs and 430 eligible but not certified clinics.
To study the association between adoption and use of EHRs in primary care clinics and HCH certification, including use of clinical decision support tools, patient registries, electronic exchange of patient information, and availability of patient portals.
Study utilized data from the 2015 Minnesota Health Information Technology Clinic Survey conducted annually by the Minnesota Department of Health. The response rate was 80% with 1,181 of 1,473 Minnesota clinics, including 662 HCH eligible primary care clinics. The comparative analysis focused on certified HCHs (311) and eligible but not certified clinics (351).
HCH clinics utilized the various tools of EHR technology at a higher rate than non-HCH clinics. This greater utilization was noted across a range of functionalities: clinical decision support, patient disease registries, EHR to support quality improvement, electronic exchange of summary care records and availability of patient portals. HCH certification was significant for clinical decision support tools, registries and quality improvement.
HCH requirements of care management, care coordination and quality improvement can be better supported with EHR technology, which underscores the higher rate of utilization of EHR tools by HCH clinics. Optimizing electronic exchange of health information remains a challenge for all clinics, including HCH certified clinics. This research presents the synergy between complementary initiatives supporting EHR adoption and HCH certification. Ultimately, improvement in health outcomes depends on effective intersection of people, processes and technology.
明尼苏达州在2007年颁布了一项立法，要求该州所有医疗服务提供者在2015年前实施一个可互操作的电子健康记录（EHR）系统。到2015年底，100%的医院和98%的诊所采用了EHR系统。明尼苏达州2008年的医疗改革包括一个医疗之家（HCH）项目，即明尼苏达州以患者为中心的医疗之家。到2014年底，43%符合HCH条件的诊所获得了认证，有335个认证的HCH和430个符合条件但未认证的诊所。
研究基层医疗诊所采用和使用EHR与HCH认证之间的关联，包括临床决策支持工具的使用、患者登记、患者信息的电子交换以及患者门户网站的可用性。
该研究利用了明尼苏达州卫生部每年进行的2015年明尼苏达健康信息技术诊所调查的数据。回复率为80%，来自明尼苏达州1473家诊所中的1181家，其中包括662家符合HCH条件的基层医疗诊所。比较分析集中在认证的HCH（311家）和符合条件但未认证的诊所（351家）。
HCH诊所比非HCH诊所更高比例地使用EHR技术的各种工具。在一系列功能中都注意到了这种更高的使用率：临床决策支持、患者疾病登记、支持质量改进的EHR、总结护理记录的电子交换以及患者门户网站的可用性。HCH认证对于临床决策支持工具、登记和质量改进具有重要意义。
EHR技术可以更好地支持HCH的护理管理、护理协调和质量改进要求，这突出了HCH诊所在EHR工具方面更高的使用率。优化健康信息的电子交换对所有诊所来说仍然是一个挑战，包括获得HCH认证的诊所。本研究展示了支持EHR采用和HCH认证的互补举措之间的协同作用。最终，健康结果的改善取决于人员、流程和技术的有效交叉。
