EHR adoption

Discussions

Manual reviews of both paper and electronic records were used to compare performance on clinical quality measures before and after EHR adoption. Performance did not change significantly before EHR adoption, while performance patterns after varied by measure. All of www.targetpayandbenefits.com the selected measures were commonly well-known and validated care recommendations monitored by payers and purchasers of health care, and for which small improvements have been observed both in national trends25 and locally in New York City.26 Much of the recent literature has highlighted the overwhelmingly positive improvement of primary and secondary preventive services after the adoption of EHR;27,28 this study highlights the specific changes observed after the conversion to EHR and the time it may take for those changes to occur.

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The level of complexity of the new workflows needed to document preventive services after EHR implementation may offer insight into the patterns of quality measure performance we observed. Diversity in practice workflow styles and preferences may also explain the lack of consensus regarding how long to wait after EHR implementation to examine its effect.29 The three trends observed—improvement, decline followed by rebound, and no change—offer examples of potential impact on practice workflow.

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Measures in which performance increases were observed soon after EHR adoption were associated with medical record elements that could all be documented within the context of a single office visit. For example, a provider can record a patient’s smoking status and vitals and can prescribe or continue a medication during a brief patient visit. Data capture of these elements does not require any further coordination or outside resources.