Do EHRs Improve Quality of Care?

Over the past few years, use of electronic health records (EHRs) have grown exponentially. However, there has not been definitive proof that EHRs help improve quality and lower costs of health care. This article reviews whether having complementary incentives to EHRs (clinical decision support, technical assistance, and financial incentives) help in improving quality of care.

Source: Juhan Sonin (Flickr/CC)

Source: Juhan Sonin (Flickr/CC)

The Primary Care Information Project (PCIP), a part of the NYC Department of Health and Mental Hygiene, subsidized EHR software costs for primary care practices in New York City. They worked with practices to help them effectively use their EHR to improve the health of their patient population. They made technical assistance available to the eligible practices and developed a clinical decision support system that provided patient-specific, point of care reminders for 10 areas of care.

Additionally, PCIP specifically developed a program that focused on delivery of four clinical preventative services: aspirin therapy, blood pressure control, cholesterol control, and smoking cessation.

Practices that were chosen to participate were randomized to receive either monetary incentives for quality and performance feedback reports or performance feedback reports alone. Financial incentives were approximately 5% of an average physician’s annual salary (paid as a lump sum at the end of the program year).

Practices eligible for this program had been on EHR for at least 3 months and had a minimum of 200 patients who were eligible for quality measurement targets.

Of the 143 practices included in the study, 71 were randomized to receive financial incentives and quality feedback and 72 were randomized to receive quality feedback alone.

The study showed an overall trend toward improvement for each of the assessed quality measures. Exposure to financial incentives was associated with significantly better performance than those that received quality feedback alone. Technical assistance was not associated with greater quality improvement for the incentivized measures but was associated with greater improvement for the unincentivized measures.

Abstract

BACKGROUND: Despite the rapid rise in the implementation of electronic health records (EHR), commensurate improvements in health care quality have not been consistently observed.

OBJECTIVES: To evaluate whether the implementation of EHRs and complementary interventions-including clinical decision support, technical assistance, and financial incentives-improved quality of care.

RESEARCH DESIGN: The study included 143 practices that implemented EHRs as part of the Primary Care Information Project-a long-standing community-based EHR implementation initiative. A total of 71 practices were randomized to receive financial incentives and quality feedback and 72 were randomized to feedback alone. All practices received technical assistance and had clinical decision support in their EHR. Using data from 2009 to 2011, we estimated measure-level fixed effects models to evaluate the association between exposure to clinical decision support, technical assistance, financial incentives, and quality of care. Associations were estimated separately for 4 cardiovascular measures that were rewarded by the financial incentive program and 4 measures that were not rewarded by incentives.

RESULTS: Financial incentives for quality were consistently associated with higher performance for the incentivized measures [+10.1 percentage points at 18 mo of exposure (approximately +22%), P<0.05] and lower performance for the unincentivized measures [-8.3 percentage points at 12 mo of exposure (approximately -20%), P<0.05]. Technical assistance was associated with higher quality for the unincentivized measures, but not for the incentivized measures.

CONCLUSIONS: Technical assistance and financial incentives-alongside EHR implementation-can improve quality of care. Financial incentives for quality may not result in similar improvements for incentivized and unincentivized measures.

PMID: 25100231

Ryan, A. Medical Care. 2014; 52 (9): 826-832.