title: Health information systems in small practices. Improving the delivery of clinical preventive services.
abstract: BACKGROUND
  Despite strong evidence that clinical preventive services (CPS) reduce morbidity and mortality, CPS performance has not improved in adult primary care. In addition to implementing electronic health records (EHRs), key factors for improving CPS include providing actionable information at the point of care, technical support staff, and quality-improvement assistance. These resources are not typically available in small practices.
  
  
  OBJECTIVE
  Estimate the impact on CPS delivery after a software upgrade to embed a clinical decision support system and practice-level quality-improvement support services.
  
  
  METHODS
  Practices were recruited from the Primary Care Information Project, a citywide initiative assisting practices adopt health information technology. Data were collected in 2009 and 2010, and analyses were conducted in 2010 and 2011. Across two time periods, receipt of CPS was calculated for 56 practices. Period 1 measured CPS delivery 2-37 months following implementation of an EHR. Period 2 measured CPS delivery within the first 6 months after an EHR software upgrade.
  
  
  RESULTS
  Substantial increases in the delivery of selected CPS were observed after the EHR software upgrades. Blood pressure control for patients with hypertension increased from 46.0% to 54.8%. Breast cancer screening, recorded BMI, and HbA1c testing for patients with diabetes also increased. More than half of the practices increased their patients' blood pressure control, recorded BMI, breast cancer screening, and HbA1c screening by ≥5 percentage points.
  
  
  CONCLUSIONS
  Delivery of CPS can increase in small primary care practices that implement an EHR that includes comprehensive quality-improvement support.
authors.affiliation: Primary Care Information Project, New York City Department of Health and Mental Hygiene, 42-09 28th Street,Queens, NY 11101-4132, USA. sshih@health.nyc.gov
authors.forename: Sarah C
authors.initials: SC
authors.lastname: Shih
authors.forename: Colleen M
authors.initials: CM
authors.lastname: McCullough
authors.forename: Jason J
authors.initials: JJ
authors.lastname: Wang
authors.forename: Jesse
authors.initials: J
authors.lastname: Singer
authors.forename: Amanda S
authors.initials: AS
authors.lastname: Parsons
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003695:Delivery of Health Care; D005260:Female; D006123:Group Practice; D006801:Humans; D008297:Male; D008490:Medical Informatics; D008875:Middle Aged; D011314:Preventive Health Services; D011787:Quality of Health Care; D014481:United States; D055815:Young Adult