title: Health Reform in Minnesota: An Analysis of Complementary Initiatives Implementing Electronic Health Record Technology and Care Coordination.
abstract: BACKGROUND
  Minnesota enacted legislation in 2007 that requires all health care providers in the state to implement an interoperable electronic health record (EHR) system by 2015. 100% of hospitals and 98% of clinics had adopted EHR systems by end of 2015. Minnesota's 2008 health reform included a health care home (HCH) program, Minnesota's patient centered medical home. By end of 2014, 43% of HCH eligible clinics were certified with 335 certified HCHs and 430 eligible but not certified clinics.
  
  
  OBJECTIVE
  To study the association between adoption and use of EHRs in primary care clinics and HCH certification, including use of clinical decision support tools, patient registries, electronic exchange of patient information, and availability of patient portals.
  
  
  METHODS
  Study utilized data from the 2015 Minnesota Health Information Technology Clinic Survey conducted annually by the Minnesota Department of Health. The response rate was 80% with 1,181 of 1,473 Minnesota clinics, including 662 HCH eligible primary care clinics. The comparative analysis focused on certified HCHs (311) and eligible but not certified clinics (351).
  
  
  RESULTS
  HCH clinics utilized the various tools of EHR technology at a higher rate than non-HCH clinics. This greater utilization was noted across a range of functionalities: clinical decision support, patient disease registries, EHR to support quality improvement, electronic exchange of summary care records and availability of patient portals. HCH certification was significant for clinical decision support tools, registries and quality improvement.
  
  
  CONCLUSIONS
  HCH requirements of care management, care coordination and quality improvement can be better supported with EHR technology, which underscores the higher rate of utilization of EHR tools by HCH clinics. Optimizing electronic exchange of health information remains a challenge for all clinics, including HCH certified clinics. This research presents the synergy between complementary initiatives supporting EHR adoption and HCH certification. Ultimately, improvement in health outcomes depends on effective intersection of people, processes and technology.
authors.affiliation: Office of Health Information Technology, Minnesota Department of Health, St. Paul, Minnesota.
authors.forename: Karen
authors.initials: K
authors.lastname: Soderberg
authors.affiliation: Public Health Informatics Program, School of Public Health, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Sripriya
authors.initials: S
authors.lastname: Rajamani
authors.affiliation: Public Health Informatics Program, School of Public Health, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Douglas
authors.initials: D
authors.lastname: Wholey
authors.affiliation: Office of Health Information Technology, Minnesota Department of Health, St. Paul, Minnesota.
authors.forename: Martin
authors.initials: M
authors.lastname: LaVenture
keywords: Informatics; electronic health records; health care homes; health care reform; patient care management