Article Figures & Data
Tables
- Table 1
Care Coordination Activities Originally Proposed as Objectives for Stage 3 of the Meaningful Use Program9
1. The clinical summary for patients should be pertinent to the office visit, not just an abstract from the medical record. 2. Use computerized provider order entry for referrals/transition of care orders. 3. Provide a summary of care record for each site transition or referral when transition or referral occurs with available information. 4. Provider receiving referral acknowledges receipt of external information and provides referral results to the requesting provider, thereby beginning to close the loop. 5. Electronic notification of a significant health care event in a timely manner to key members of the patient’s care team (significant event = arrival at an emergency department, admission to a hospital, discharge from an emergency department or hospital, or death). 6. Generate lists of patients for multiple specific conditions and present near real-time patient-oriented dashboards. -
Note: The final list of proposed care coordination objectives that was submitted for consideration to the Office of the National Coordinator for Health Information Technology was updated and differs from this original list. The 3 referral-related objectives were merged under a single objective. Additionally, the objective that contained “real-time patient-oriented dashboards” was not included in the final list. (Source: HITPC Meaningful Use Stage 3 Final Recommendations. Office of the National Coordinator for Health Information Technology. http://www.healthit.gov/sites/faca/files/HITPC_MUWG_Stage3_Recs_2014-04-01.pdf. Published Apr 1, 2014. Accessed Mar 15, 2015.)
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Characteristic Practices, % PCMH level: Level 3 76.9 Practice type Community health center 26.0 Health system–owned practice 26.3 Physician-owned, <5 FTE clinicians 25.1 Physician-owned, ≥5 FTE clinicians 22.6 Financial concern: very concerned (N = 345) 34.2 EHR system vendor (N = 343) eClinicalWorks 20.7 Allscripts 14.6 NextGen 14.0 Epic 13.4 GE/Centricity 7.0 Other 30.3 Have a nonclinician in charge of care coordination 58.3 Demonstration/pilot project participation and PCMH payment Both 46.0 Demonstration/pilot project only 16.6 Payment for PCMH only 17.1 Neither 20.3 Type of area Urban 28.3 Suburban 45.1 Rural 26.6 Received consultation/collaboration help for care coordination (N = 336) 76.5 Characteristic Mean (SD) Priority for Care Coordination scorea 6.7(2.2) Priority for Implementing Meaningful Use scorea 7.5(2.0) Change Process Capability Questionnaire, Strategies scale scoreb 10.2(3.9) -
EHR = electronic health record; FTE = full-time equivalent; GE = General Electric; PCMH = patient-centered medical home.
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↵a On a scale of 0 to 10 points. Higher scores indicate greater perceived priority.
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↵b On a scale of 0 to 17 points. Higher scores indicate greater capability to undertake change.
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Care Coordination Activity Practices, % Routinely Perform Activity Routinely Use Health IT to Perform Activity 1. Provide patients with clinical summaries of their visits 81.4 76.6 2. Send referral requests to other clinicians 92.3 68.6 3. Provide a comprehensive medical summary for each site transition or referral 69.4 45.4 4. Respond to requests for additional information from clinician receiving referral 90.0 54.0 5. Provider receiving referral provides referral results to the requesting provider 82.0 53.4a 6. Provide reminders for guideline-based interventions or screening tests to clinicians at the point of care 74.3 64.9 7. Identify patients who have had an emergency department visit 63.1 39.4 8. Identify patients who have had a hospital admission/discharge 75.4a 48.9 9. Have a system for remote access to patient’s medical record n/a 80.9 10. Track referrals 51.7 Track urgent referrals until results or report come back 68.6a Track nonurgent referrals until results or report come back 57.4 -
IT = information technology (computerized/electronic health record system); n/a = not applicable.
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↵a Significant difference seen across practice types at P <.025 (Bonferroni adjustment for 20 comparisons).
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- Table 4
Associations of Practice Characteristics With Care Coordination Activities and Health IT Use
Performance of All 10 Care Coordination Activities Use of Health IT for Care Coordination (Health IT Index) Characteristic Practices, %a (N = 350) OR (95% CI)b (N = 332) Mean Scorec (N = 350) β Coefficientb (N = 332) P Value Overall 21.1 – 5.8 – – Practice type, Community health centers 18.7 1.6 (0.8–3.8) 5.4 −0.3 .41 Health system owned 16.3 Ref 5.9 Ref Physician owned, <5 FTE clinicians 25.0 1.7 (0.9–3.9) 6.1 0.3 .45 Physician owned, ≥5 FTE clinicians 25.3 1.5 (0.7–3.4) 6.0 −0.1 .80 PCMH level Level 1 or 2 16.1 Ref 5.4 n/a n/a Level 3 22.7 1.6 (0.7–3.4) 6.0 n/a n/a Financial concern Less than very concerned 23.8 Ref 5.9 Ref n/a Very concerned 14.4 0.4 (0.2–0.8)d 5.6 −0.4 .13 Have nonclinician in charge of care coordination No 14.4 Ref 5.3 Ref n/a Yes 26.0 1.9 (1.0–3.5)d 6.2 0.7 .01 Type of area Urban 12.1 Ref 5.5 n/a n/a Rural or suburban 24.7 2.5 (1.2–5.3)d 6.0 n/a n/a Received consultation/collaboration help for care coordination No 8.9 Ref 4.8 Ref n/a Yes 25.3 2.6 (1.1–6.4)d 6.2 0.6 .06 Change Process Capability Questionnaire, Strategies scalee 1.1 (1.1–1.2)f 1.1 (1.0–1.2)d,f 5.8 0.2 <.0001 -
FTE = full-time equivalent; IT = information technology (computerized system/electronic health record system); n/a = not applicable; OR = odds ratio; PCMH = patient-centered medical home; Ref = Reference group.
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↵a Unadjusted.
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↵b From multivariate regression analysis.
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↵c Unadjusted; on a scale of 0 to 10, where higher score indicates greater number of coordination activities performed with health IT.
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↵d Statistically significant.
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↵e On a scale of 0 to 17.
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↵f For a 1-unit change in score.
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- Table 5
Importance of Health IT Capabilities for Improving Care Coordination Related to Originally Proposed Stage 3 Meaningful Use Objectives
Capability Practices Rating Capability as “Very Important,”a % Provide patients with clinical summaries of their visits (N = 346) 47.7 Use computerized provider order entry for referrals/transition of care orders (N = 346) 45.4 Provide a Summary of Care record for each site transition or referral (N = 343) 42.3 Provider receiving referral acknowledges receipt of external information (N = 343) 32.9 Provider receiving referral provides referral results to the requesting provider (N = 345) 69.6 Generate lists of patients for multiple specific conditions (N = 346) 53.8 Present near real-time patient-oriented dashboards for patients with multiple specific conditions (N = 339) 40.1 Having electronic notification of a visit of the following type: Patients’ arrival at an emergency department (N = 345) 42.9 Patients’ discharge from an emergency department (N = 344) 59.0 Patients’ admission to a hospital (N = 345) 66.4 Patients’ discharge from a hospital (N = 346) 77.5 Patients’ death (N = 345) 73.0 -
IT = information technology (computerized system/electronic health record system).
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↵a Rating of 5 on a scale of 1 to 5.
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Additional Files
Supplemental Tables
Supplemental Tables
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The Article in Brief
Health IT-Enabled Care Coordination: A National Survey of Patient-Centered Medical Home Clinicians
Suzanne Morton , and colleagues
Background Electronic health records (EHRs) and other health information technology (health IT) could help coordinate patient care by making information-sharing easier. Implementing some aspects of care coordination is an expectation for clinicians in the Centers for Medicare and Medicaid Services EHR Incentive Program for "meaningful use" of health IT. This study assessed whether six proposed care coordination objectives for Stage 3 of the Meaningful Use program are feasible and acceptable. The objectives related to referrals, notification of care from other facilities, patient clinical summaries, and patient dashboards.
What This Study Found Even among practices having a strong commitment to the medical home model, use of health information technology to support care coordination objectives is not consistent and often not aligned with clinicians' priorities. Specifically, of 350 practices surveyed, 78 percent viewed timely notification of hospital discharges as very important, yet only 49 percent used heath IT systems to accomplish this task. The activity most frequently supported by health IT was providing clinical summaries to patients (77 percent of practices); however, only 48 percent considered this activity very important. Fewer than one-half of practices routinely used computerized systems to identify patients seen in emergency department or hospital settings or to send a comprehensive care summary to other providers. Overall, 21 percent of clinicians reported that their practices performed all of the 10 care coordination activities evaluated and on average conducted six of the 10 activities using EHR/health IT systems. Having a stronger capacity to change and having a nonclinican responsible for care coordination was positively associated with greater use of health IT to support care coordination activities.
Implications
- Use of health IT for care coordination was higher than that seen in in earlier national physician surveys. The authors conclude, however, that many practices will need financial and technical assistance to support care coordination objectives.
