title: Quality measure performance in small practices before and after electronic health record adoption.
abstract: BACKGROUND
  To date, little research has been published on the impact that the transition from paper-based record keeping to the use of electronic health records (EHR) has on performance on clinical quality measures. This study examines whether small, independent medical practices improved in their performance on nine clinical quality measures soon after adopting EHRs.
  
  
  METHODS
  Data abstracted by manual review of paper and electronic charts for 6,007 patients across 35 small, primary care practices were used to calculate rates of nine clinical quality measures two years before and up to two years after EHR adoption.
  
  
  RESULTS
  For seven measures, population-level performance rates did not change before EHR adoption. Rates of antithrombotic therapy and smoking status recorded increased soon after EHR adoption; increases in blood pressure control occurred later. Rates of hemoglobin A1c testing, BMI recorded, and cholesterol testing decreased before rebounding; smoking cessation intervention, hemoglobin A1c control and cholesterol control did not significantly change.
  
  
  CONCLUSIONS
  The effect of EHR adoption on performance on clinical quality measures is mixed. To improve performance, practices may need to develop new workflows and adapt to different documentation methods after EHR adoption.
  
  
  CONCLUSIONS
  In the short term, EHRs may facilitate documentation of information needed for improving the delivery of clinical preventive services. Policies and incentive programs intended to drive improvement should include in their timelines consideration of the complexity of clinical tasks and documentation needed to capture performance on measures when developing timelines, and should also include assistance with workflow redesign to fully integrate EHRs into medical practice.
authors.affiliation: New York City Department of Health and Mental Hygiene.
authors.forename: Colleen M
authors.initials: CM
authors.lastname: McCullough
authors.affiliation: New York City Department of Health and Mental Hygiene.
authors.forename: Jason J
authors.initials: JJ
authors.lastname: Wang
authors.affiliation: Montefiore Medical Center.
authors.forename: Amanda S
authors.initials: AS
authors.lastname: Parsons
authors.affiliation: New York City Department of Health and Mental Hygiene.
authors.forename: Sarah C
authors.initials: SC
authors.lastname: Shih
references.citation: J Gen Intern Med. 2013 Apr;28(4):496-503
references.pmid: 23054927
references.citation: N Engl J Med. 2003 May 29;348(22):2218-27
references.pmid: 12773650
references.citation: J Am Med Inform Assoc. 2011 Dec;18 Suppl 1:i91-5
references.pmid: 21856688
references.citation: J Gen Intern Med. 2010 Jan;25 Suppl 1:72-6
references.pmid: 20077156
references.citation: Ann Intern Med. 2005 Aug 2;143(3):222-6
references.pmid: 16061920
references.citation: J Med Pract Manage. 2010 May-Jun;25(6):342-9
references.pmid: 20695245
references.citation: J Am Med Inform Assoc. 2012 Jul-Aug;19(4):604-9
references.pmid: 22249967
references.citation: J Gen Intern Med. 2013 Jan;28(1):107-13
references.pmid: 22926633
references.citation: Am J Prev Med. 2011 Dec;41(6):603-9
references.pmid: 22099237
references.citation: Am J Manag Care. 2012 Feb 01;18(2):e48-54
references.pmid: 22435884
references.citation: Perspect Health Inf Manag. 2012;9:1d
references.pmid: 22737096
references.citation: J Am Med Inform Assoc. 2010 Jan-Feb;17(1):104-7
references.pmid: 20064810
references.citation: Health Aff (Millwood). 2009 Mar-Apr;28(2):345-56
references.pmid: 19275989
references.citation: Int J Med Inform. 2010 Jul;79(7):492-500
references.pmid: 20478738
references.citation: N Engl J Med. 2012 Jun 14;366(24):2243-5
references.pmid: 22693996
references.citation: Health Aff (Millwood). 2011 Mar;30(3):464-71
references.pmid: 21383365
references.citation: Med Econ. 2012 Jul 25;89(14):52, 54-5
references.pmid: 22953485
references.citation: J Am Med Inform Assoc. 2005 Sep-Oct;12(5):505-16
references.pmid: 15905487
references.citation: Prev Chronic Dis. 2013 Aug 01;10:E130
references.pmid: 23906330
references.citation: J Am Med Inform Assoc. 2011 Sep-Oct;18(5):704-10
references.pmid: 21527407
references.citation: BMJ. 2005 Mar 12;330(7491):581
references.pmid: 15760999
references.citation: Perspect Health Inf Manag. 2010 Oct 01;7:1d
references.pmid: 21063545
references.citation: Health Aff (Millwood). 2013 Mar;32(3):562-70
references.pmid: 23459736
references.citation: Health Aff (Millwood). 2013 Jan;32(1):53-62
references.pmid: 23297271
references.citation: Ann Intern Med. 2006 May 16;144(10):742-52
references.pmid: 16702590
references.citation: BMJ. 2005 Dec 3;331(7528):1313-6
references.pmid: 16269467
references.citation: Health Aff (Millwood). 2011 Mar;30(3):481-9
references.pmid: 21383367
references.citation: Health Serv Res. 2012 Aug;47(4):1522-40
references.pmid: 22250953
references.citation: N Engl J Med. 2011 Sep 1;365(9):825-33
references.pmid: 21879900