Health IT: Selected Publications

Informing Public Policy | Evaluating Impacts | Affect on Consumers

Informing Public Policy

"Necessary But Not Sufficient: The HITECH Act and Health Information Technology’s Potential to Build Medical Homes." Lorenzo Moreno, Deborah Peikes, and Amy Krilla, June 2010. This paper examines how the HITECH Act could be harnessed to help practices implement technology and support key principles of the PCMH.

Evaluating Impacts

"Toward Understanding EHR Use in Small Physician Practices." Health Care Financing Review, Suzanne Felt-Lisk, Lorraine Johnson, Christopher Fleming, Rachel Shapiro, and Brenda Natzke, fall 2009. This article presents insights into the use of electronic health records (EHRs) by small physician practices participating in a Centers for Medicare & Medicaid Services pay-for-performance demonstration. Site visits to four states revealed slow movement toward improved EHR use. Factors facilitating use of EHRs include customization of products and being owned by a larger organization. Factors limiting use include system limitations, cost, and lack of strong incentives to improve. Many practices also increased use of medical assistants after implementing EHRs.

"Health Information Exchange: The Role of Safety-Net Providers." Trends in Health Informatics, Issue Brief #5. Suzanne Felt-Lisk, Melanie Au, and Patricia Higgins, June 2009. Health information technology has great potential for improving health care through Health Information Exchange (HIE), the exchange of health-related information electronically across providers, with strong privacy, confidentiality, and security protections. If safety-net providers are to keep pace with other providers, organizations responsible for funding and facilitating expansion of HIE need a solid understanding of safety-net providers’ needs. A new brief reviews lessons learned from a 13-member panel convened to discuss barriers and catalysts safety-net providers face in integrating HIE.

"Using Payment Incentives to Improve Care for the Chronically Ill in Medicare: First Year Implementation of the Medicare Care Management Performance Demonstration (MCMP)." Suzanne Felt-Lisk, Christopher Fleming, Brenda Natzke, and Rachel Shapiro, March 2009. The MCMP demonstration aims to improve quality and coordination of care for chronically ill Medicare beneficiaries and to promote adoption and use of health information technology (HIT) by small-to medium-sized primary care practices. This report looks at implementation experiences, use of electronic health records, and care management activities in eight primary care practices in each of the four participating states: Arkansas, California, Massachusetts, and Utah. MCMP appears to have prompted improvements to documentation of care and, to a lesser extent, modest positive operational changes in many of the practices. Changes are typically inconsistently applied based on practitioner and staff time and interest.

"New Hospital Information Technology: Is It Helping to Improve Quality?" Trends in Health Care Quality, Issue Brief #3. Suzanne Felt-Lisk, May 2006. Although health information technology (IT) is at the center of efforts to improve the nation’s health care system by enhancing patient safety and reducing inefficiencies, little evidence exists to link IT to quality improvements and efficiency gains. This new issue brief reports on how six types of information technology have affected hospital quality, based on interviews with senior hospital executives. The findings suggest that IT has been an important factor in enhancing quality, particularly in terms of more timely clinical information, diagnosis, and treatment.

Affect on Consumers

"Costs to Medicare of the IDEATel Home Telemedicine Demonstration: Findings from an Independent Evaluation." Diabetes Caresubscription required. Lorenzo Moreno, Stacy B. Dale, Arnold Y. Chen, and Carol A. Magee, July 2009. Home telemedicine holds promise for cost-effective delivery of monitoring, educational, and therapeutic services to people with chronic illnesses. The authors report that findings from Mathematica's congressionally mandated evaluation of the Informatics for Diabetes Education and Telemedicine (IDEATel) demonstration showed no overall cost savings for Medicare. The demonstration was neither as intensive nor as technologically sophisticated as originally designed. It was clinically effective at only one site and had no cost-reducing effect on the use of expensive services, such as hospital care. Furthermore, the intervention's costs were high—more than $8,000 per person per year—when compared with costs for programs with similar-sized clinical impacts. The demonstration's specific type of home telemedicine intervention was not generalizable to other telemedicine interventions. As a result, findings from the evaluation do not imply that home-based telemedicine cannot increase value for the Medicare program.

"Personal Health Records: What Do Underserved Consumers Want?"Trends in Health Informatics, Issue Brief #4. Lorenzo Moreno, Stephanie Peterson, Ann Bagchi, and Raquel af Ursin, May 2007. Personal health information is a valuable resource to individuals and their families, as well as health care providers. This issue brief describes the features of 21 software-based Personal Health Records (PHRs) and assesses whether the features match the needs and preferences of underserved individuals, most of them minorities who face economic, cultural, or linguistic barriers to health care, and often have low health and computer literacy. The brief notes that underserved minorities want PHRs that are portable, secure, private, and simple. In addition, many said they would pay modest set-up and update fees, but would be reluctant to pay maintenance fees. The brief is based on focus groups conducted with individuals from underserved low-income minority groups to discuss PHRs and their capacity to improve health care.

"Considerations in Designing Personal Health Records for Underserved Populations."Trends in Health Care Disparities, Issue Brief #1. Ann Bagchi, Lorenzo Moreno, and Raquel af Ursin, April 2007. Hurricanes Katrina and Rita brought the utility and importance of electronic, easily portable personal health records (PHRs) starkly to light in fall 2005. A new issue brief describes the role that PHRs—comprehensive paper- or electronic-based systems recording an individual's health-related information over time—can play in reducing health care disparities. The brief also looks at barriers to PHR adoption for underserved individuals and the implications of widespread use of PHRs. Based on focus groups conducted with individuals from medically underserved, low-income minority groups from New Brunswick, NJ, the brief suggests that a variety of outreach efforts may be needed by developers of PHR systems to overcome consumer mistrust before PHRs are accepted on a wider scale.