Study: Even PCMH-Recognized Practices Fall Short on Stage 3 Care Coordination Requirements

Even among the top health IT-enabled primary care practices, a large amount of physicians are still doing care coordination the old fashioned way.

This was one of the core findings of new research published in the Annals of Family Medicine. Researchers, led by the National Committee for Quality Assurance (NCQA), examined how 350 primary care practices who had achieved patient centered medical home (PCMH) recognition would stack up against many of the Stage 3 requirements for care coordination. What they found was the care coordination activities most routinely implemented by these practices were the ones that did not require health IT support. 

Even though 77 percent of the surveyed physicians listed timely electronic notification of a discharge as very important, only 49 percent had adopted the capability. In a similar vein, less than half of the respondents--many of whom achieved Level 3 PCMH recognition from NCQA--were using computerized systems to send a comprehensive care summary to other providers. 

Meanwhile, the non-health IT care coordination required activities, such as sending referral requests to other clinicians and responding to a request for additional information from a referring clinician, had the highest rates of adoption. While some physicians used health IT to complete these activities, many did not. The researchers found that many practices with EHRs that had data exchange capabilities were still using secure e-mail or fax for most care coordination activities with outside physician offices and facilities.

Clinicians viewed other potential care coordination technologies, such as patient dashboards, low on the priority list. Only 20 percent of the practice met all 10 care coordination requirements proposed for Stage 3 of meaningful use. Most saw time (39 percent), money and other resources (35 percent), and IT/EHR systems as the major barriers to data exchange. 

It wasn't all negative though. Researchers did note that certain computerized data exchange capabilities, such as tracking referrals and providing clinical care summaries, were trending in a positive direction compared to a previous study. Overall though, they recommend greater delegation to non-clinicians and improvements in systematic capability to improve data exchange, as well as additional technical, financial and educational support for practices.