Meaningful Use of Electronic Health Records and Ambulatory Healthcare Quality Measures

Abstract

Introduction Electronic Health Record (EHR) adoption rates for office-based physicians doubled between 2008 and 2015, from 42% to 89%, and more than 60% of all office-based physicians achieved meaningful use by 2016. The US government has paid billions of dollars in incentives to promote EHR meaningful use. Nonetheless, evidence linking EHR meaningful use to quality measures improvements is limited. Objective This study aims to examine the relationship between EHR meaningful use and capabilities among four quality measures in an ambulatory healthcare setting. Study design A cross-sectional study design of the 2015-2016 National Ambulatory Medical Care Survey dataset. Methods We used adjusted multivariate regression models to examine associations between (a) EHR meaningful use and (b) 10 EHR-computerized capabilities, with four quality measures (blood pressure screening, tobacco use screening, obesity screening, and obesity education). Results We analyzed 30,787 office visits, representing an annual estimate of 680 million national office visits. Results showed that 95% of visits were to offices meeting EHR meaningful use criteria. We found one positive association between EHR meaningful use and obesity screening (OR= 3.5, 95% CI [1.742-6.917]). We also found eight positive associations between EHR capabilities and three quality measures (screening for blood pressure and obesity, and obesity education). These associations included five EHR-computerized capabilities: "record patient problem list", "view lab results", "Reminders for interventions/screening", "Order lab results" and "Recording clinical notes". No EHR capability was associated with screening for tobacco use. Conclusions We looked at a handful of screening-oriented quality measures in ambulatory healthcare and found limited associations with EHR meaningful use but multiple positively significant associations with EHR capabilities. Although EHR meaningful use has become more commonly used, offering substantial administrative efficiency over paper records, current patterns of EHR meaningful use do not always appear to translate into a better quality of care in physician offices. However, quality measures used represent limited procedures for a handful of specific conditions and not the overall healthcare aspect.

Keywords: ambulatory care setting; electronic health records; meaningful use; national ambulatory medical care survey; offices-based physician; quality measures; screening.