AMIA2014 Workflow Paper (Sunday): The Impact of HIT on Cost and Quality in Patient-Centered Medical Home Practices

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3:30PM Sunday

“While health IT is thought to play a critical role in supporting new models of care delivery, we know little about the extent to which HIT improves cost and quality outcomes. We studied a large patient-centered medical home (PCMH) program to assess which types of HIT led to improvements in composite performance outcomes: PMPM cost, chronic disease management, medication management, and preventive care. At baseline, registries were associated with lower PMPM spending (-$19.37; p<0.05). Over time, practices that newly adopted EHRs had smaller gains in chronic disease management adherence relative to non-adopters (diff-in-diff: -1.55%; p<0.05). We failed to find a relationship between other types of HIT – ePrescribing and PHRs/Portals – and our composite outcomes. The lack of consistent relationship between HIT adoption and improved performance suggest that these tools may not yet support the clinical activities and approaches to patient engagement that enable PCMHs to deliver higher-quality, lower-cost care .... newly adopted HIT may hurt performance in the near term by disrupting workflows, introducing complexity, and reducing the time that providers can devote to clinical practice transformation. However, once practices become comfortable with the technology and are able to invest in optimizing its use, the benefits may appear. Some of this optimization may also come in the form of more advanced HIT functionalities."
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