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Health Information Technology

The adoption of electronic medical records (EMR) in ambulatory settings has been widely recommended by both the Institute of Medicine and the Future of Family Medicine project as a means to reduce errors and improve the quality of health care. To date, the majority of EMR research has been conducted in large integrated health systems. These systems use in-house developed EMRs and have access to technical support resources and information sharing capacities that are important to ensuring meaningful use of this technology. These resources are typically not present in privately owned, community primary care practices where most of the care in the US is delivered. These differences make it difficult to translate the findings from these studies into patient care improvements in the unaffiliated community practice setting. With the passage of the American Recovery and Reinvestment Act in February 2009 which includes mandates and incentives for expand health information technology (HIT) use along with incentives to use e-prescribing tools both as stand alone systems or as part of a full-function EMR offered through Medicare, independent community practices are likely to adopt EMRs in increasing numbers. Therefore, understanding how these practices can effectively use commercially available EMRs to improve the quality, safety and efficiency of health care is paramount.

Our research team is conducting cutting-edge research that examines health information technology use in primary care practice, with particular emphases on understanding and improving EMR use among independent, community-based practices where EMR use and patient care process are not well understood and on building an improved understanding of what drives variation in implementation and use of EMRs and other HIT such as e-prescribing in these settings. Working in partnership with collaborators around the country we are committed to developing the knowledge base and tools needed to help primary care practices use these technologies to improve care.

Our grants and papers in this area are indicative of a vibrant and growing body of research in this area that positions our team to improve care quality in primary care practices by helping practices make the necessary work flow and organizational changes for optimizing health information technology use in this setting.

PUBLICATIONS:

  • Bell DS, Schueth AJ, Guinan JP, Wu S, Crosson JC. Evaluating the technical adequacy of electronic prescribing standards: results of an expert panel process. AMIA Annual Symposium Proceedings, 2008:46-50. PMID: 18999287
  • Crosson JC, Isaacson N, Lancaster D, McDonald EA, Schueth AJ, DiCicco-Bloom B, Newman
    JL, Wang CJ, Bell DS. Variation in electronic prescribing implementation among twelve
    ambulatory practices. J Gen Intern Med, 2008; 23(4): 364-71.
  • Crosson JC, Ohman-Strickland PA, Hahn KA, DiCicco-Bloom B, Shaw E, Orzano AJ, Crabtree
    BF. Use of electronic medical records and diabetes quality of care: results from a sample of
    family medicine practices. Ann Fam Med 2007 May-June; 5(3): 209-15.
  • Crosson JC, Stroebel C, Scott J, Stello B, Crabtree BF.  Implementing an electronic medical
    record in a family medicine practice: Communication, decision-making, and conflict.  Ann
    Fam Med. 2005; 3(4):307-311.
  • Hahn KA, Ohman-Strickland PA, Cohen DJ, Piasecki AK, Crosson JC, Clark EC, Crabtree
    BF. Electronic medical records are not associated with improved documentation in
    community primary care practice. Journal (Under review).
  • Wang CJ, Patel MH, Schueth AJ, Bradley M, Wu S, Crosson JC, Glassman PA, Bell DS. Perceptions of standards-based electronic prescribing systems as implemented in outpatient primary care: a physician survey. Journal of the American Medical Informatics Association. 2009;16:493–502. PMID: 19390106

GRANTS:

Funded

  • Cohen, PI. “Cardiovascular Disease Care and EMR use in community-based primary care practice.” Funded by the National Heart, Lung and Blood Institute. (1 R21 HL092046-01A2) Dates of Activity: 9/1/2009 – 8/30/2011.
  • Crosson, PI. “Building an implementation toolset for e-prescribing (subcontract).” Funded by the Agency for Healthcare Research and Quality. (HHSA290200600017  TO#4, PI for overall project: Bell, RAND Health Corporation/UCLA) Dates of Activity: 8/1/08 – 9/30/10.
  • Crosson, PI. “Tests of Medicare's initial electronic prescribing standards in the New Jersey e-prescribing action coalition (subcontract).” Funded by the Agency for Healthcare Research and Quality/Centers for Medicare and Medicaid Services. (1 U18 HS016391-01, PI for overall project: Bell, RAND Health Corporation/UCLA) Dates of Activity: 1/1/06 – 12/31/06

Pending

  • Cohen, PI.  “The role of EMRs in communicating about medication management.” R21 submitted to the Agency for Healthcare Research Quality. Anticipated Dates: 7/2010-6/2012.