Evaluation of the Electronic Health Records Demonstration
Electronic health records (EHRs)—computerized patient medical files—have the potential to improve quality of care, reduce medical errors, and lower administrative costs. However, incorporating them into clinical practice requires large investments in new technology, in addition to changes in existing clinical systems and processes of care.
The Electronic Health Records Demonstration, designed and implemented by the Centers for Medicare & Medicaid Services (CMS), aims to improve quality of care and reduce Medicare costs through the adoption and use of electronic health records in small to medium-sized primary care practices serving Medicare beneficiaries with chronic illnesses. Mathematica is conducting an eight-year evaluation of the demonstration.
Physician practices in selected sites were randomly assigned to two groups—a demonstration group that gets incentive payments in addition to regular Medicare fees, and a comparison group that receives only standard Medicare fees. Financial incentives are being paid over the five years of the demonstration to as many as 400 primary care physician practices in 4 participating sites. The four sites, which began implementation in June 2009, are in Louisiana; Maryland/Washington, DC; Pittsburgh, Pennsylvania and surrounding counties; and South Dakota and surrounding counties in Iowa, Minnesota, and North Dakota. Incentive payments will be awarded based on a standardized survey measuring the number of EHR system functions (such as e-prescribing or ordering laboratory tests electronically) a physician group has incorporated into its practice.
In addition, data will come from Medicare claims and large-scale surveys of Medicare beneficiaries and physicians in both demonstration and comparison groups. The evaluation includes a rigorous analysis of demonstration impacts on use of Medicare-covered services and expenditures, as well as quality measures. It also includes an implementation analysis based on site visits and telephone contacts with physician practices to learn from their experiences in implementing the technology.
Evaluation findings will estimate the impact of providing financial incentives to physician group practices to adopt and use EHRs and to improve the quality of care for Medicare beneficiaries with chronic illnesses, as well as describing how practices adopted EHR systems and any barriers they faced along the way.