Health IT Alone Won't Improve Primary Care

Federal report raises numerous questions about whether electronic health records and other technologies can advance the patient centered medical home model.

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Health information technology can be a strong facilitator for the establishment of the patient centered medical home (PCMH), but health IT alone is not a panacea for building an efficient model, a government study reveals.

Published last month by the Department of Health and Human Services' Agency for Healthcare Research and Quality, the report, "Necessary but Not Sufficient: The HITECH Act and Health Information Technology's Potential to Build Medical Homes," said available evidence on the ability of health IT to support the medical home is mixed.

While some evidence suggests that health IT improves the cost effectiveness, efficiency, quality, and safety of medical care delivery, there is not broad evidence of success. "It may take 5 to 10 years to figure out the full unintended effects of health IT on transforming practices into medical homes," the report said.

Opponents of health IT argue that "if you computerize an inefficient system, you will simply make it inefficient faster." These critics warn that health IT alone will not positively transform primary care delivery systems. They say a more realistic approach would be to identify the specific health IT capabilities that could help practices become successful medical homes, the document said.

As the healthcare system undergoes a technological transformation, the report examines the potential effects of the planned accelerated adoption of electronic health record (EHR) and other technologies under the Health Information Technology for Economic and Clinical Health (HITECH) Act and its implications for the five principles that encompass the medical home.

The five principles are:

  • A patient-centered orientation toward the "whole person" that requires understanding the patient's and the family's preferences and providing the patient's entire range of care needs.

  • Comprehensive, team-based care, which relies on a team of providers to meet the patient's care needs.

  • Care coordination across all elements of the complex healthcare system.

  • Continuous access to care.

  • A system-based approach to quality and safety, such as having a practice use evidence-based medicine and clinical decision-support tools to guide decisions.

The HITECH programs and initiatives underway to promote the adoption of technology support the medical home in some areas but are found wanting in others, the report suggests.

Take the patient-centered, whole-person orientation, for example. The report says if implemented well, some HITECH programs could support a whole-person orientation. However, the report notes there's a caveat: "special attention would have to be given to support behavioral-health inclusion in this principle, since care for behavioral disorders and substance use is typically segregated from general medical care. Further, the ability to coordinate this care would be challenging, because the use of health IT by behavioral-care providers lags in comparison to that of medical care providers."

The report says comprehensive team-based care could be advanced through two HITECH programs. The Strategic Health IT Advanced Research Projects (SHARP) program will fund research focused on achieving breakthrough advances in "patient-centered cognitive support" for providers. The other program is the Community College Consortia to Educate Health IT Professionals which, jointly with the Curriculum Development Centers program, help to integrate health IT into the clinical education of healthcare professionals.

"These initiatives could be invaluable for offering would-be primary care providers detailed information about the medical home concept, how to operate it, and how health IT could support the building process," the report said.

For coordinated care, the document said the HITECH Act doesn't include programs that would explicitly facilitate care coordination or integration across all elements of the complex healthcare system.

While the HITECH Act fosters the adoption of health IT standards and the secure exchange and use of health information, which prevents the risk of providers developing computer silos, the report notes that the "legislation is silent about how primary care providers will be able to communicate with the practice's 'medical neighborhood' (the other providers seen by the patients), either from a technical or a legal (agreement on data-sharing) perspective."

With regard to continuous access to care, the report says "there are neither specific HITECH programs nor health reform legislation that explicitly addresses this medical home principal."

Finally, the report notes that there are three HITECH programs that address the broad principle of improved quality, safety, efficiency, and reducing health disparities.

"In addition to the Beacon Community's emphasis on whole-person orientation and the State Health Information Exchange Program, [the Office of the National Coordinator for Health Information Technology] has proposed the HIT Extension Program. This initiative will assist providers in adopting and using certified EHR systems through HIT Regional Extension Centers (RECs). Furthermore, the legislation established a national Health Information Technology Research Center (HITRC), which will gather and share relevant information on best practices in EHR adoption, effective use, and provider support and help convene the collaboration of regional centers," the report said.

In its assessment of whether the HITECH Act and its programs to promote health IT adoption can help to support the transformation by primary care practices to the PCMH model, the report says:

"In sum, all these HITECH programs and current Federal legislation are necessary, but not sufficient elements for providers considering the adoption of the medical home model. As noted by a panel of experts consulted for this project, HITECH's finding is not enough to support adoption and meaningful use of EHRs, let along the broader transformation in care delivery needed to build PCMH."

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