Physicians who adopted electronic health records (EHRs) in 2012 and participated in new models of payment and care delivery were more likely to perform care processes, such as population health, associated with improved care delivery, according to a study published in the American Journal of Managed Care.
The study authors, using data from physicians participating in the 2012 National Ambulatory Medical Care Survey Physician Workflow Survey, also found providers using EHRs were significantly more likely to perform care processes, specifically care coordination, patient communication, population management and quality measurement, than those not using the systems. And, according to the study, physicians participating in new delivery and payment models, such as accountable care organizations (ACOs) and patient-centered medical homes (PCMH), were more likely to routinely perform these processes.
Researchers from the Office of the National Coordinator for Health Information Technology (ONC) and the Centers for Disease Control and Prevention (CDC) and Mathematica Policy Research used data from more than 2,500 responses to the 2012 NAMCS Physician Workflow Survey to examine the relationship between EHR use, participation in alternative payment models and improved care delivery.
The 2012 NAMCS survey included 14 separate items that queried physicians on 14 specific care processes in 4 categories: population management, quality measurement, patient communication, and care coordination.
The researchers found that in 2012, 62 percent of office-based physicians were using an EHR, with about half of all physicians using an EHR that was certified to meet meaningful use criteria. More than one in five physicians (22 percent) were participating in either an ACO (16 percent) or PCMH (9 percent) and 4 percent were participating in both models. Overall, 18 percent of physicians were participating in an ACO or PCMH and also reported using an EHR.
The majority of physicians (89 percent), including those without EHRs, routinely performed at least one care process, according to the study. Sixty-nine percent engaged in patient communication, 89 percent engaged in care coordination and 67 percent reported engaging in population management. Less than half (44 percent) reported performing quality measurement processes routinely.
“There was variation in the extent to which physicians routinely performed specific processes within each category. For example, the population management processes ranged from 13 percent for creating lists of patients by lab results to 58 percent for providing patients with reminders for follow-up or preventive care, Among physicians who routinely performed a given process, the majority reported that the process was computerized,” the study authors wrote.
According to the study results, physicians using EHRs were 15 percentage points more likely than physicians without EHRs to routinely perform at least one population management process. Among physicians not participating in either type of initiative (ACOs or PCMHs), using an EHR was associated with a 14 to 27 percentage point greater likelihood of routinely performing at least one care processes in three of the four categories.
However, across all categories, physicians who had an EHR and had adopted the patient-centered medical home model or joined an ACO were between 6 and 22 percentage points more likely to routinely perform the care processes than physicians with EHRs alone.
“Our analysis highlights several specific areas—including population management processes that require the aggregation and analysis of individual patient data and communication with patients and other care team members—where additional technology and policy supports may be important to facilitate wider adoption of these activities,” the study authors wrote.
