UNDERSTANDING SMALL PRIMARY CARE PRACTICE PHYSICIANS' PERSPECTIVES ON ELECTRONIC HEALTH RECORD SYSTEM DECISIONS AND IMPLEMENTATION, PRACTICE IMPACTS AND MEANINGFUL USE: A QUALITATIVE STUDY
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Date
2017-01-01
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School of Public Policy
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Public Policy
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Access limited to the UMBC community. Item may possibly be obtained via Interlibrary Loan through a local library, pending author/copyright holder's permission.
Abstract
Abstract Purpose: The Department of Health and Human Services developed the Meaningful Use Incentive Program with the goal of having physicians and hospitals incorporate electronic health record systems (EHRs) in their practice to improve care, gather data, and spur interoperability among providers. Primary care practices with 10 or fewer primary care providers have been impacted by these federal regulations. Small practice groups lagged behind in Meaningful Use participation at the inception of the program and their perspectives are not well known. Methods: An interview guide was developed after literature review and in-depth semi-structured interviews were conducted with primary care physician (PCP) practices in Maryland consisting of 10 or fewer PCPs. The interviews were with a diverse sampling of PCPs who were identified through various physician group affiliations and referrals until thematic saturation occurred. The interviews were transcribed, reviewed and thematically coded. Results: Eleven interviews were conducted with primary care practices in the state of Maryland. Themes, such as similar impacts on practices and patient care after utilization of EHRs under the Meaningful Use requirements and variable interoperability emerged. There was positive feedback for EHRs generally that had been utilized prior to the Meaningful Use program. Concerns included unnecessary/redundant data collection, physician penalties based on patient behaviors, preventable and unexpected cost expenditures and time spent in complying with the program, and a flatline impact on patient care. Barriers to participation or continued participation included limited resources (time and cost), patient compliance, distrust of why data were collected, and frustration with changing program requirements. Conclusion: The majority of PCPs responded that patient care was not positively impacted by the program. Respondents struggled with the patient portal and secure direct electronic messaging with other providers requirements due to patient behavior being beyond their control. Most concluded that interoperability was not possible in the near future so long as there was limited standardization within the EHR industry. Physicians recognized the utility of EHRs in their practices when the software was customized to their practice rather than imposed by regulatory requirements that were time-consuming and often inapplicable to their practices. Federal programs meant to improve care may be perceived as burdensome to physicians and could negatively impact patient care. Although this study is exploratory, it revealed areas for further research that policy makers should consider such as the impact of regulations on small primary care practice physicians' ability to deliver the best care possible. Requiring compliance with multiple federal programs and imposing physician penalties could impact physician satisfaction and may not be the optimal method to obtain the health policy goals of reducing costs and improving care. Finally, interoperability may be premature for the health care market, particularly for small practices due to inconsistencies with EHR technologies.