title: Health IT-Enabled Care Coordination: A National Survey of Patient-Centered Medical Home Clinicians.
abstract: OBJECTIVE
  Health information technology (IT) offers promising tools for improving care coordination. We assessed the feasibility and acceptability of 6 proposed care coordination objectives for stage 3 of the Centers for Medicare and Medicaid Services electronic health record incentive program (Meaningful Use) related to referrals, notification of care from other facilities, patient clinical summaries, and patient dashboards.
  
  
  METHODS
  We surveyed physician-owned and hospital/health system-affiliated primary care practices that achieved patient-centered medical home recognition and participated in the Meaningful Use program, and community health clinics with patient-centered medical home recognition (most with certified electronic health record systems). The response rate was 35.1%. We ascertained whether practices had implemented proposed objectives and perceptions of their importance. We analyzed the association of organizational and contextual factors with self-reported use of health IT to support care coordination activities.
  
  
  RESULTS
  Although 78% of the 350 respondents viewed timely notification of hospital discharges as very important, only 48.7% used health IT systems to accomplish this task. The activity most frequently supported by health IT was providing clinical summaries to patients, in 76.6% of practices; however, merely 47.7% considered this activity very important. Greater use of health IT to support care coordination activities was positively associated with the presence of a nonclinician responsible for care coordination and the practice's capacity for systematic change.
  
  
  CONCLUSIONS
  Even among practices having a strong commitment to the medical home model, the use of health IT to support care coordination objectives is not consistent. Health IT capabilities are not currently aligned with clinicians' priorities. Many practices will need financial and technical assistance for health IT to enhance care coordination.
authors.affiliation: National Committee for Quality Assurance, Washington, DC morton@ncqa.org.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Morton
authors.affiliation: Primary Care Information Project, New York City Department of Health and Mental Hygiene, New York, New York.
authors.forename: Sarah C
authors.initials: SC
authors.lastname: Shih
authors.affiliation: University of Washington, Seattle, Washington.
authors.forename: Chloe H
authors.initials: CH
authors.lastname: Winther
authors.affiliation: Evolent Health, Arlington, Virginia.
authors.forename: Aldo
authors.initials: A
authors.lastname: Tinoco
authors.affiliation: University of Vermont College of Medicine, Burlington, Vermont.
authors.forename: Rodger S
authors.initials: RS
authors.lastname: Kessler
authors.affiliation: National Committee for Quality Assurance, Washington, DC.
authors.forename: Sarah Hudson
authors.initials: SH
authors.lastname: Scholle
mesh_terms: D057286:Electronic Health Records; D006282:Health Personnel / Q000706:statistics & numerical data*; D006801:Humans; D062527:Meaningful Use / Q000592:standards*; D008490:Medical Informatics / Q000379:methods*; D018802:Patient-Centered Care / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000458:organization & administration*; D012017:Referral and Consultation; D057566:Self Report; D014481:United States
keywords: care coordination; electronic health records; meaningful use; patient-centered medical home; practice-based research; primary care; technology