Use of Health IT for Care Coordination in PCMHs

Although there has been improvement in the use of health information technology (IT) for care coordination, fewer than half of patient-centered medical homes (PCMHs) routinely use computerized systems to identify patients seen in emergency departments or hospitals or to send care summary to other providers, according to a new study published in the Annals of Family Medicine.

Researchers surveyed physician-owned and hospital/health system—affiliated primary care practices that have achieved PCMH recognition and participated in the Meaningful Use (MU) program in order to assess the feasibility and acceptability of 6 proposed care coordination objectives for stage 3.

“The care coordination activities most routinely implemented were not the ones with the greatest degree of health IT support,” the authors found.

Use of a system for identifying patients with an emergency department visit was at only 38.8%, while use for providing clinical summaries to patients was at 76.6%. More than 90% of all clinicians reported routinely sending referral requests and responding to information requests from clinicians receiving referrals.

Just one-fifth of respondents reported their practices performed all 10 care coordination activities, with 6 of 10 activities being conducted using health IT systems.

Respondents rated timely electronic notifications of hospital discharges as the most important (77.5%) objective, with patient deaths a close second (73%). Clinicians reported that they least valued specialists’ acknowledgement of patient information (32.9%) and real-time patient dashboards (40.1%). They cited time, money, and IT/electronic health record systems as the greatest barriers (in that order) to coordinating patient care with other practices and facilities.

Greater support for care coordination, geographic location, and having a nonclinician responsible for care coordination were all associated with a greater implementation of care coordination activities. Meanwhile, practices that were concerned with their financial health had lower implementation of care coordination activities.

“Practices vary in their capability to perform the proposed MU stage 3 objectives related to care coordination,” concluded the authors. “Greater delegation to nonclinicians and improvements in systemic capability for change may improve practices’ ability to perform care coordination activities with electronic support.”