Patient-centered medical homes don't maximize HIT to coordinate care

Physicians practicing in patient-centered medical homes (PCMHs) still depend on non-health IT methods of coordinating care, and their use of electronic health records for supporting coordinated care were not aligned with their priorities, according to a new study from the Annals of Family Medicine.

EHRs have the promise of making information sharing easier. The researchers, from the National Committee for Quality Assurance and elsewhere, assessed the feasibility and acceptability of the care coordination objectives originally proposed in Stage 3 of the Meaningful Use program in 2012. They specifically evaluated practices at the forefront of this "developing" area--those with PCMH certification--since PCMHs place a high priority on care coordination.

However, the study found that only 21.1 percent of the 350 respondents performed all 10 coordinated care activities, and only six out of 10 did so with health IT. Fewer than half routinely used computerized systems to identify patients in the hospital or emergency department. Moreover, the care coordination activities most routinely implemented were not the ones with the greatest degree of health IT support. The greatest barriers to electronic coordinated care were time, money and IT/EHR issues.

The researchers also found that practices with staff specifically assigned to coordinate care--as well as those that had more capability for change--were more likely to coordinate care, and to do so electronically.  

"Computerized systems often don't support the care coordination activities that clinicians value most," the researchers said. "To improve uptake of health IT for care coordination to meet clinicians' needs, practices will need technical assistance to help redesign workflows and enhance technologic capabilities. For other activities not highly valued by clinicians, such as using patient dashboards for population management, even greater technical assistance will likely be needed as well as education to highlight their benefits."

Other studies also have found that EHRs can help clinicians in PCMHs coordinate patient care, but as currently designed don't provide sufficient support.  

Coordinated care and data sharing are major components of health reform and the newer provider reimbursement models, as well as for Stage 3 of Meaningful Use. The proposed rule implementing Stage 3 was released in March; comments are due May 29.

To learn more:
- read the study