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Kate Monica 

Researchers named EHR system customization as one of ten strategies that ease patient-centered medical home implementation.

EHR system customization can help to streamline the implementation of the patient-centered medical home (PCMH) model, according to new research published in the Journal of the American Board of Family Medicine (JABFM.)

PCMHs are designed to boost patient health outcomes at both the individual and population level while reducing healthcare organization costs and improving the patient experience. To achieve this aim, PCMHs prioritize enabling care coordination through EHR technology, health data exchange, data analytics, and population health management tools.

Researchers conducted interviews and focus group discussions with providers from 20 Patient-Centered Primary Care Homes (PCPCHs) in Oregon between 2015 and 2016 to learn about the challenges of PCMH implementation.

The team of researchers from the Oregon Health and Science University and Portland State University School of Public Health found that clinic leaders and staff from all 20 PCMHs reported similar challenges when implementing the care model. However, study participants used a variety of different strategies to overcome these obstacles.

Ultimately, researchers identified ten strategies that may be effective in overcoming common barriers to PCMH implementation, one of which was EHR system customization.

Clinic leaders reported that EHR use enabled provider communication and allowed clinicians to access specific health data about individual patients, patient populations, or other clinics.

“However, minute data entry differences could render a search useless if it was unable to capture all relevant data,” noted researchers in the report. “Clinics standardized data entry protocols; however, this did not address all issues of data analysis.”

Clinic leaders reported they had customized their EHR systems with additional tools to ensure the technology included all necessary data analytics capabilities to support the PCMH model.

“EHRs did not provide tools for data analysis, so clinics purchased third-party analysis tools, used basic Excel spreadsheets, or used existing staff to conduct analyses,” explained researchers. “In some cases, a staff member emerged as a data expert, shifting their role into a data management and analysis position.”

“For other clinics, the task was incorporated into each staff member’s role in addition to their existing responsibilities,” continued researchers. “Clinic staff frequently requested funding for data management and analysis staff or tools.”

In addition to EHR system customization, researchers also cited health data exchange as a useful strategy for ensuring continuity of care with providers at outside clinics, hospitals, specialty care facilities, and pharmacies.

“Many clinics were concerned that patients were not receiving continuity of care outside of the clinic via their pharmacists, specialists, and hospitals,” maintained researchers.

“Patients often did not give information to their providers, assuming that if one specialist knew, all providers knew,” the team continued. “Specialists also told clinics that they sent information via the EHR, not realizing that their EHR systems were incompatible.”

Providers made efforts to thoroughly follow through on patient referrals to overcome problems with continuity of care and health data exchange. Some providers formed partnerships with specialists to facilitate patient referrals, while others took time to remind patients and specialists of the myriad communication barriers that could delay referrals.

“Some interviewees reported additional challenges with specialists, and to a lesser degree, hospitals, neglecting to send patient records,” researchers wrote. “This was less of an issue with hospitals, as many had EHR access or formal agreements with the clinics.”

Some clinic leaders tracked and flagged specialists that neglected to engage in health data exchange. Furthermore, some providers threatened to stop referring patients to any specialists that refused to share patient EHRs.

Other strategies clinic leaders used to overcome challenges related to PCMH model implementation included integrating behavioral and mental health into primary care, incorporating screening, prevention, and disease management services, and preventing unnecessary emergency department visits.

Healthcare organizations interested in adopting the PCMH model can use these strategies to streamline the care model implementation process. As more healthcare organizations work to improve the patient experience, boost patient health outcomes, and cut costs, clinic leaders can look toward successful PCMHs as examples of how to achieve value-based care.

“What is important above all else is the dedication to continuous learning through implementation,” researchers concluded.