142nd APHA Annual Meeting and Exposition

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On target with HIIT: Adoption of electronic health record systems in a large urban county, and uptake in clinics serving indigent patients in a Medicaid health plan, 2010 to 2013

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Tuesday, November 18, 2014

S. Rae Starr, MPhil, MOrgBehav , HealthCare Outcomes & Analysis, L.A. Care Health Plan, Los Angeles, CA
The HITEC Act of 2009 provided financial incentives for providers to deploy health information technologies in their practices.  This paper reports selected findings from one of the programs launched under that initiative.

(1) Background: Los Angeles County, California, has in excess of 7,000 active physicians, connecting with specialists and services in complex contractual relationships. Prior to the initiative, penetration of electronic health records (EHR) in the market serving the indigent population was not high. Reliable access to health information is particularly crucial for coordination and planning of care.

(2) Objective: To analyze the degree of adoption of HIIT by participating providers, and assess potential exposure to the benefits of this technology by patients in different demographic groups, and by patients in different geographical regions within the county.

(3) Methods: The study uses EHR adoption data from one of the 60 regional HITEC projects.  To examine benefits to patients, the study links doctors to their patients, to permit analyzing exposure to EHR functionality by patients from different demographic groups in different geographical areas. 

(4) Results: Initial findings from data in hand for this ongoing study indicate that in excess of 5,000 providers are participating.  Between launch in 2010 and the 3rd quarter 2013, approximately 1/3 of participating doctors had an EHR.  Durations from signup to Go-live varied widely, as did elapsed time between Go-live and attaining meaningful use.

(5) Discussion: The briefing will report providers’ degree of adoption of health information technologies, and the length of time required to attain meaningful use.  Provider group structures most conducive to adoption of information technology will be described.  The accessibility of the technology to different demographic groups will be discussed.  Geographical dispersion of the technology will be examined, to determine whether where a patient lives, determines degree of access to providers using EHR.

Learning Areas:

Biostatistics, economics
Communication and informatics
Conduct evaluation related to programs, research, and other areas of practice
Implementation of health education strategies, interventions and programs
Planning of health education strategies, interventions, and programs

Learning Objectives:
Describe the degree of adoption of health information technologies within a large urban provider network. Assess the pace and degree to which adopters attain meaningful use. Differentiate the degree of HIIT adoption between provider organizations that are centralized vs decentralized in structure. Discuss how “where you live” in a large urban county affects the likelihood of receiving services in a clinic that has an EHR and has attained meaningful use. Compare different demographic groups on access to clinics with EHR. Assess whether adoption of HIIT is associated with improvements in the quality of services that patients receive.

Keyword(s): Information Technology, Performance Measurement

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: Served eight years as Senior Biostatistician at the largest public health plan in the United States, serving Medicaid and Medicare populations in an ethnically diverse urban county in the southwest United States. The work involved demographic and geographical analysis of quality measures data; studies of physician use of handheld computers for e-Prescribing; and analysis of initial data from a large program promoting EHR use.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.