Electronic Health Records and Support for Primary Care Teamwork

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Background

Electronic health records (EHRs) and clinician teamwork have emerged as complementary approaches to strengthening the provision of primary care. For this Commonwealth Fund–supported study, researchers interviewed clinical and administrative staff at 27 primary care practices recognized as patient-centered medical homes by the National Committee for Quality Assurance, as well as three national experts on primary care, about the practical effects of these changes and how practices are overcoming challenges.

What the Study Found

Interviewees believed EHRs enhance communication within their practice teams. They also pointed out that EHRs, along with revised clinical workflows, can allow nonphysicians to take on expanded roles, freeing physicians to focus on more complex aspects of care.

Practice staff also noted challenges, and suggested potential solutions:

  • Many EHR systems lack a registry capability for tracking patient data; in other cases, the registry does not work with the practice’s other systems. Some practices worked with their parent organization’s IT department or a third party to generate reports, while others purchased third-party software as a workaround.
  • Most practices said their EHR lacked a care management tool, leaving care managers unable to input notes and track patients’ progress. Some practices customized their EHRs for such documentation, but believe vendors need to work alongside practicing clinicians to devise a longer-term strategy.
  • Some clinicians in practices owned by larger health systems said their compliance, coding, or legal departments claim that only certain staff members can enter or view parts of the EHR. The experts interviewed noted that the team as a whole should be accountable for data entry, just as it is for care; other respondents said regulatory and state boards should consult with physicians on this issue.

Conclusions

Primary care practices should work with health IT experts to bridge the gap between workflow and EHR use, and communicate to vendors the enhancements practices need.

Publication Details

Publication Date: February 6, 2015
Authors: Ann S. O’Malley, Kevin Draper, Rebecca Gourevitch, Dori A. Cross, and Sarah Hudson Scholle
Summary Writer: Deborah Lorber
Citation:
A. S. O’Malley, K. Draper, R. Gourevitch et al., “Electronic Health Records and Support for Primary Care Teamwork,” Journal of the American Medical Informatics Association, published online Jan. 27, 2015.
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