Without continued support, low-resource primary care physician practices may meet Stage 1 Meaningful Use only to fail to progress further, contributing to the increasing "digital divide," according to a study published this month in the Annals of Family Medicine.
There's been considerable research on the implementation of electronic health records but not much on how well primary care providers maintain their use. The researchers, from the University of Alberta in Canada, and elsewhere, noted that health IT by its nature requires periodic updates, such as training and addressing computer bugs. They evaluated low-resource providers by both interview and observation from two projects in Michigan; one involving federally qualified health centers and the other involving physicians in the state's regional extension center (REC) program.
The researchers found that to successfully maintain health IT, the primary care providers need managerial, organizational and change management expertise; technical support; and vendor relationships. Rural providers had additional challenges, such as intermittent Internet service.
The study revealed that without ongoing support, these practices will not make it beyond Stage 1 of Meaningful Use. Unfortunately, they added, there isn't much in the way of such support.
Uneven adoption of EHRs unintentionally increases health disparities, as providers with more resources have an easier time with implementation and are more likely to earn incentive payments and avoid penalties. Lawmakers have called on the Office of the National Coordinator for Health IT and the Centers for Medicare & Medicaid Services to leverage the development of Stage 3 of the Meaningful Use program to reduce and potentially eliminate health disparities.
"[T]he multifaceted challenge of health IT maintenance will almost inevitably overwhelm low-resource practices," the study's authors warned. "The operational and financial consequences of falling behind in maintenance will mean lower quality care for the patients in areas these practices serve--or quite possibly no care at all."
The authors suggested that providers receive some incremental resources, such as a more open-ended REC program.
To learn more:
- read the study