Health Information Exchange in Small Primary Care Practices
Context: The future of health care includes electronic health records (EHR) and Health Information Exchange (HIE) with the goal of creating a National Health Information Network. Efforts to date have been based in hospitals or large ambulatory care settings, with far less written about HIE in smaller primary care clinics. Objective: The goal of this project was to assess the benefits and barriers that influence the participation of primary care practices in community-wide HIE. Design: Clinics’ background data regarding practice composition and use of EHR/HIE was collected with an on-line questionnaire. On-site structured interviews with at least three key informants were conducted at each clinic. Interviews were audio-taped, transcribed and analyzed for themes by the researchers. Setting: Nine ambulatory clinics with fewer than 20 primary care physicians in three geographic regions of Minnesota. Participants: Six clinics were rural and three urban, all but one were not-for-profit, three were federally qualified health centers. Six clinics were using a purchased EHR, one had created a relational database system, and two were in the process of acquiring an EHR. Two clinics participated in a Regional Health Information Organization (RHIO). Key informants included clinic administrators, medical directors, nurse managers, IT support staff, and physician IT champions. Results: Clinics using EHR/HIE described improvements in timeliness of communication, quality of care, and patient data tracking. Strategic planning that involved staged implementation of EHR/HIE and having clinician champions who were knowledgeable about IT were important factors for success. Cost was a barrier, with several of the clinics overcoming this with federal and state funding mechanisms. Other barriers include political, liability and patient privacy challenges. Conclusions: HIE is developing by incremental steps within small practices. It is important to consider the successes and challenges faced by such practices when setting over-arching policies about HIE.
Zink, T. M.,
& Kralewski, J.
(2010). Health Information Exchange in Small Primary Care Practices. North American Primary Care Research Group, 42 (Suppl 2).
This presentation was given at The 2009 NAPCRG Annual Meeting in Montreal, Quebec, November, 2009.