Appl Clin Inform - Predictors of success for electronic health record implementation in small physician practices.

Tópicos

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Resumo

CKGROUND: The federal government is promoting adoption of electronic health records (EHRs) through financial incentives for EHR use and implementation support provided by regional extension centers. Small practices have been slow to adopt EHRs.OBJECTIVES: Our objective was to measure time to EHR implementation and identify factors associated with successful implementation in small practices receiving financial incentives and implementation support. This study is unique in exploiting quantitative implementation time data collected prospectively as part of routine project management.METHODS: This mixed-methods study includes interviews of key informants and a cohort study of 544 practices that had worked with the Primary Care Information Project (PCIP), a publicly funded organization that since 2007 has subsidized EHRs and provided implementation support similar to that supplied by the new regional extension centers. Data from a project management database were used for a cohort study to assess time to implementation and predictors of implementation success.RESULTS: Four hundred and thirty practices (79%) implemented EHRs within the analysis period, with a median project time of 24.7 weeks (95% CI: 23.3 - 26.4). Factors associated with implementation success were: fewer providers, practice sites, and patients; fewer Medicaid and uninsured patients; having previous experience with scheduling software; enrolling in 2010 rather than earlier; and selecting an integrated EHR plus practice management product rather than two products. Interviews identified positive attitude toward EHRs, resources, and centralized leadership as additional practice-level predictors of success.CONCLUSIONS: A local initiative similar to current federal programs successfully implemented EHRs in primary care practices by offsetting software costs and providing implementation assistance. Nevertheless, implementation success was affected by practice size and other characteristics, suggesting that the federal programs can reduce barriers to EHR implementation but may not eliminate them.

Resumo Limpo

ckground feder govern promot adopt electron health record ehr financi incent ehr use implement support provid region extens center small practic slow adopt ehrsobject object measur time ehr implement identifi factor associ success implement small practic receiv financi incent implement support studi uniqu exploit quantit implement time data collect prospect part routin project managementmethod mixedmethod studi includ interview key inform cohort studi practic work primari care inform project pcip public fund organ sinc subsid ehr provid implement support similar suppli new region extens center data project manag databas use cohort studi assess time implement predictor implement successresult four hundr thirti practic implement ehr within analysi period median project time week ci factor associ implement success fewer provid practic site patient fewer medicaid uninsur patient previous experi schedul softwar enrol rather earlier select integr ehr plus practic manag product rather two product interview identifi posit attitud toward ehr resourc central leadership addit practicelevel predictor successconclus local initi similar current feder program success implement ehr primari care practic offset softwar cost provid implement assist nevertheless implement success affect practic size characterist suggest feder program can reduc barrier ehr implement may elimin

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