Limits...
Understanding the Impact of Electronic Medical Record Use on Practice-Based Population Health Management: A Mixed-Method Study.

Vaghefi I, Hughes JB, Law S, Lortie M, Leaver C, Lapointe L - JMIR Med Inform (2016)

Bottom Line: Finally, building on the results of the qualitative analysis, we identified factors facilitating the integration of PBPH.Our results suggest that EMR usage is pivotal in setting the foundation to support PBPH.The wide range of performance variation among EMR-enabled clinics suggests that EMR functionality and optimization, its support of clinical practice workflow, and policy issues to ensure adoption of standards are critical issues to facilitate PBPH.

View Article: PubMed Central - HTML - PubMed

Affiliation: School of Management, State University of New York at Binghamton, Binghamton, NY, United States. svaghefi@binghamton.edu.

ABSTRACT

Background: Practice-based population health (PBPH) management is the proactive management of patients by their primary care clinical team. The ability of clinics to engage in PBPH and the means by which they incorporate it in a clinical setting remain unknown.

Objective: We conducted the Canadian Population Health Management Challenge to determine the capacity and preparedness of primary care settings to engage in PBPH using their existing medical record systems and to understand the complexities that may exist in PBPH implementation.

Methods: We recruited a sample of electronic medical record (EMR) -enabled and paper-based clinics from across Canada to participate in the challenge. The challenge required clinic staff and physicians to complete time-controlled, evidence-based practice reviews of their patients who may benefit from evidence-informed care, treatment, or interventions across five different areas (immunization, postmyocardial infarction care, cancer screening, diabetes management, and medication recall). We formulated a preparedness index to measure the capacity of clinics to engage in PBPH management. Finally, we conducted follow-up qualitative interviews to provide richer understanding of PBPH implementation and related issues (ie, challenges and facilitators).

Results: A total of 11 primary care clinics participated, representing 21 clinician practices. EMR-enabled clinics completed a full review of charts in an average of 1.37 hours. On the contrary, paper-based clinics reviewed nearly 10% of their charts in an average of 3.9 hours, hinting that they would have required an estimated 40 hours to complete a review of charts in their practice. Furthermore, the index revealed a major gap in preparedness between the EMR and paper-based clinics (0.86-3.78 vs 0.05-0.12), as well as a broad range among the EMR clinics. Finally, building on the results of the qualitative analysis, we identified factors facilitating the integration of PBPH.

Conclusions: Our results suggest that EMR usage is pivotal in setting the foundation to support PBPH. The wide range of performance variation among EMR-enabled clinics suggests that EMR functionality and optimization, its support of clinical practice workflow, and policy issues to ensure adoption of standards are critical issues to facilitate PBPH.

No MeSH data available.


Related in: MedlinePlus

Overall ranking based on the average preparedness score across included modules in the Canadian Population Health Management Challenge. EMR: Electronic medical record-enabled clinics; Paper: Paper-based clinics.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
getmorefigures.php?uid=PMC4835667&req=5

figure1: Overall ranking based on the average preparedness score across included modules in the Canadian Population Health Management Challenge. EMR: Electronic medical record-enabled clinics; Paper: Paper-based clinics.

Mentions: Figure 1 illustrates each clinic’s rankings based on their overall average preparedness score. See Multimedia Appendix 2 for a detailed data summary of the module results for participating clinics.


Understanding the Impact of Electronic Medical Record Use on Practice-Based Population Health Management: A Mixed-Method Study.

Vaghefi I, Hughes JB, Law S, Lortie M, Leaver C, Lapointe L - JMIR Med Inform (2016)

Overall ranking based on the average preparedness score across included modules in the Canadian Population Health Management Challenge. EMR: Electronic medical record-enabled clinics; Paper: Paper-based clinics.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4835667&req=5

figure1: Overall ranking based on the average preparedness score across included modules in the Canadian Population Health Management Challenge. EMR: Electronic medical record-enabled clinics; Paper: Paper-based clinics.
Mentions: Figure 1 illustrates each clinic’s rankings based on their overall average preparedness score. See Multimedia Appendix 2 for a detailed data summary of the module results for participating clinics.

Bottom Line: Finally, building on the results of the qualitative analysis, we identified factors facilitating the integration of PBPH.Our results suggest that EMR usage is pivotal in setting the foundation to support PBPH.The wide range of performance variation among EMR-enabled clinics suggests that EMR functionality and optimization, its support of clinical practice workflow, and policy issues to ensure adoption of standards are critical issues to facilitate PBPH.

View Article: PubMed Central - HTML - PubMed

Affiliation: School of Management, State University of New York at Binghamton, Binghamton, NY, United States. svaghefi@binghamton.edu.

ABSTRACT

Background: Practice-based population health (PBPH) management is the proactive management of patients by their primary care clinical team. The ability of clinics to engage in PBPH and the means by which they incorporate it in a clinical setting remain unknown.

Objective: We conducted the Canadian Population Health Management Challenge to determine the capacity and preparedness of primary care settings to engage in PBPH using their existing medical record systems and to understand the complexities that may exist in PBPH implementation.

Methods: We recruited a sample of electronic medical record (EMR) -enabled and paper-based clinics from across Canada to participate in the challenge. The challenge required clinic staff and physicians to complete time-controlled, evidence-based practice reviews of their patients who may benefit from evidence-informed care, treatment, or interventions across five different areas (immunization, postmyocardial infarction care, cancer screening, diabetes management, and medication recall). We formulated a preparedness index to measure the capacity of clinics to engage in PBPH management. Finally, we conducted follow-up qualitative interviews to provide richer understanding of PBPH implementation and related issues (ie, challenges and facilitators).

Results: A total of 11 primary care clinics participated, representing 21 clinician practices. EMR-enabled clinics completed a full review of charts in an average of 1.37 hours. On the contrary, paper-based clinics reviewed nearly 10% of their charts in an average of 3.9 hours, hinting that they would have required an estimated 40 hours to complete a review of charts in their practice. Furthermore, the index revealed a major gap in preparedness between the EMR and paper-based clinics (0.86-3.78 vs 0.05-0.12), as well as a broad range among the EMR clinics. Finally, building on the results of the qualitative analysis, we identified factors facilitating the integration of PBPH.

Conclusions: Our results suggest that EMR usage is pivotal in setting the foundation to support PBPH. The wide range of performance variation among EMR-enabled clinics suggests that EMR functionality and optimization, its support of clinical practice workflow, and policy issues to ensure adoption of standards are critical issues to facilitate PBPH.

No MeSH data available.


Related in: MedlinePlus