Study finds tech support crucial to small-practice EHR use

When it comes to EHR implementation in small practices, physicians need sustained, high-intensity technical assistance in order to achieve positive gains in patient care, according to a study published in the January issue of Health Affairs.

The research was conducted by Weill Cornell Medical College and the Primary Care Information Project (PCIP) of the New York City Health Department. PCIP is the largest community-based EHR implementation program in the United States, providing technical assistance and education to more than 7,200 providers through its regional extension center, NYC REACH.

The study found EHR implementation alone was not enough to improve patient care overall or known "EHR-sensitive" quality improvement measures, such as cancer screenings and diabetes care.

"EHRs were once thought to be a cure-all for helping improve patient care, but there are implementation issues and the technology has a steep learning curve," said Andrew Ryan, lead author of the study and assistant professor of public health at Weill Cornell Medical College. "Our study shows EHRs can in fact be a tool for quality improvement but not in isolation."

"Technical assistance must be at the heart of the EHR implementation process," Ryan said. "Under-resourced, small physician practices -- especially those taking care of underserved populations -- need help to effectively use EHR technology to improve patient quality of care."

Researchers reported it took physician practices a minimum of nine months of EHR exposure, combined with eight or more technical assistance visits, to demonstrate any significant statistical improvements in certain key quality measures, including breast cancer screening, retinal exam and urine testing for diabetes patients, chlamydia screening for women and colorectal cancer screening.

Physician offices with minimal or no technical support did not show any significant improvements, even when those practices had been using EHRs for up to two years, the study found.

To evaluate the effects EHRs have on patient care within small physician practices, the research team used an independent data source to analyze multi-payer medical claims in New York state from the New York Quality Alliance, linking the data to small practices enrolled in the PCIP.

The New York City Health Department initiative provided subsidized EHR software with clinical decision support and onsite technical assistance to 3,300 physicians at 600 primary care practices in underserved neighborhoods serving disadvantaged populations to improve quality of care.

"These study findings are consistent with observations from our field staff that small physician practices serving the disadvantaged areas of New York City need considerably more technical support to use EHRs to improve quality," said Sarah Shih, executive director of Health Care Quality Information and Program Evaluation at PCIP. "High-intensity technical support has helped improve the quality of care provided by small physician practices in some key quality measures after nine months."