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Study: 40 Percent of Ambulatory Care Practices "Under-Users" of EHR Tools

January 26, 2018
by Heather Landi
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Nearly 40 percent of U.S. ambulatory care practices are “under-users” of health information technology functionalities, which impacts the ability of the health system as a whole to provide coordinated, efficient care, a recent study found. What’s more, those “under-users” are more likely to be smaller, rural and specialty ambulatory care practices.

The study, conducted by Juliet Rumball-Smith, Ph.D., Paul Shekelle, M.D., Ph.D. and Cheryl Damberg, Ph.D., was published in American Journal of Managed Care. The study explored variation in the extent of use of electronic health record (EHR)-based health information technology functionalities across U.S. ambulatory care practices. Use of health IT functionalities in ambulatory care is important for delivering high-quality care, including that provided in coordination with multiple practitioners, the study stated.

Researchers used data from the 2014 Healthcare Information and Management Systems Society (HIMSS) Analytics survey. The responses of 30,123 ambulatory practices with an operational EHR were analyzed to examine the extent of use of EHR-based health IT functionalities for each practice. The researchers based their methodology on seven domains of EHR-based health IT functionalities—data repository, clinical decision support, order entry management, electronic messaging, results management, health information exchange, and patient use.

Looking at EHR use, the researchers identified practices that were high users of a range of functionalities (“super-users”) and those that used these EHR tools only minimally (“under-users”). And, the researchers investigated how the odds of super-use and under-use varied by practice size, type, urban or rural location, and geographic region.

For the study, there were 38,638 health system-affiliated practices in the HIMSS data; 32,236 (83.4 percent) indicated they had a live and operational EHR, and of these, 30,123 (93.5 percent) provided survey responses.

The study found that among 30,123 practices that were affiliated with a health system and had an operational EHR, only 27 percent were “super-users,” meaning they were maximally using EHR functionalities designed to improve patient care and facilitate high-quality performance across the broader health system. Of concern was that nearly 40 percent (38.9 percent) of ambulatory practices were categorized as “under-users,” indicating minimal use of the EHR and associated health IT functionalities. What’s more, “under-use” was more likely in smaller practices, those located outside of metropolitan centers, non–primary care practices, and those situated in the West.

The researchers also contend that there are likely multiple factors involved in EHR and health IT under-use by ambulatory care practices. Cost has been cited as the primary barrier to adopting an EHR system, the researchers stated. “Similarly, upgrading a basic EHR to one more comprehensive may not be financially possible for practices with limited resources. Cost may also be a factor for these practices because of the health IT support resources required to train users and maintain the systems,” the study authors wrote.

Smaller and rural practices were more likely to be under-users, a pattern also seen in the adoption of EHR and health IT in hospitals, according to the study. “These types of practices may face financial, human resource, or structural barriers that impede their ability to use their EHR to full capacity. We found that super-use was least prevalent in practices providing specialist-level care and services; it is possible that these practices are less well served by existing health IT functionalities and require specific tools developed for more specialized clinical scenarios,” the study authors wrote.

The researchers concluded that to achieve the broader benefits of the EHR and health IT, health systems and policy makers need to identify and address barriers to full use of health IT functionalities. And, the researchers note that under-use of these tools has “far-reaching implications.” Suboptimal use of critical health IT functionalities may have direct relevance for the quality of care provided by an individual practice as part of routine patient care, the researchers noted. And, user-use of these technologies, such as health information exchange, may have consequences for the quality of care provided across the ambulatory care sector.

Current policies, such as shared risk programs, encourage community-based strategies. This trend, combined with the expanding diversity of ambulatory care providers, suggest that communication and care coordination among ambulatory care providers is more crucial than ever.

The study authors wrote, “We suggest that policy makers identify the barriers limiting the use of these tools in ambulatory care (in particular those related to small, rural, and specialty practices) and consider how best to facilitate the full use of a range of EHR-based health IT functionalities. Investment in EHR-based health IT capacity of individual ambulatory practices will likely have benefits to providers across the ambulatory setting and to the performance of the broader health system.”

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