Advanced Use of Electronic Health Records in Patient-Centered Medical Homes

Abstract

Electronic Health Records (EHRs) offer the promise of improved health outcomes through care coordination, in particular for costly and difficult to manage chronic illness. Adoption levels of EHRs in primary care have increased significantly since the recent Meaningful Use policy initiative began incentivizing EHRs in 2011; however, the full benefits of EHRs will only be realized once widespread use of advanced EHR functions is achieved. Patient-Centered Medical Homes (PCMHs) are considered the pinnacle of primary care and are expected to rely heavily on EHRs to coordinate care across settings. The goals of this dissertation are to describe and discuss overall EHR adoption and use in PCMH practices, including the practices’ progress towards meeting advanced criteria for the Meaningful Use policy, and to identify and explain the specific PCMH practice characteristics and contextual factors associated with advanced EHR use. This dissertation utilizes innovative data on PCMHs to create and evaluate an advanced EHR use index and explore the iterative differences distinguishing advanced EHR use from no advanced use in PCMHs. The EHR index is the dependent variable defining the levels of advanced EHR use by the PCMH. Four models of advanced EHR use are created and variations in the models are explored to validate the EHR index and identify the PCMH practice characteristics associated with advanced EHR use at higher levels of the EHR index. This dissertation indicates higher EHR adoption and use levels for PCMHs compared to other office-based and primary care practices in the current literature. Practice size, type, and location (rural versus non-rural) of the PCMH demonstrate unique associations with advanced EHR use. Contrary to prior studies, this dissertation indicates that larger PCMHs as well as federally-funded centers are less likely to be advanced EHR users and that practice affiliation (being part of a network) has no association with advanced use; also, smaller and non-rural PCMHs practices that are physician or hospital/system-owned are more likely to be using advanced EHR functions, which is also contrary to previous research. These findings have significant implications for future policies, practice, and research. As advanced EHR use becomes more widespread, the findings from this study provide future researchers with robust baseline data on PCMHs. The measures of EHR adoption and use levels in this study, as well as the various models tested, provide frameworks for future studies to evaluate and track advanced EHR use in primary care.