Key Lessons from the National Evaluation of the CHIPRA Quality Demonstration Grant Program
Applying health information technologies (IT) for QI
Table of Contents
CMS encouraged States to develop and enhance current health IT applications, establish links among databases, provide incentives for the adoption and use of health IT, analyze health IT data, and implement QI activities based on the analyses. Federal policymakers were looking to this demonstration to provide information on the use and impact of health IT to improve child health care quality and reduce costs, and to inform technical assistance to promote broader adoption of health IT. CMS’ grant solicitation required States to coordinate with other Federal grant programs underway at the time.8
Fourteen demonstration States implemented health IT projects,9 exploring a mix of strategies for using technology to improve quality of care. Key strategies included using combinations of EHRs, personal health record (PHRs), and health information exchanges (HIEs) to support:
- Automated reporting of measures in the Child Core Set.
- EPSDT reporting.
- Clinical screening and decision support.
- Coordinating among different types of providers (especially in connection with medical homes) through secure information sharing pathways.
- Engaging consumers through patient portals and secure email.
- Adapting EHR systems to better meet the needs of child-serving practices.
Implementing health IT applications to support QI for children typically takes far longer and requires more resources than program staff anticipate. In addition, new Federal guidelines and the rapid evolution of health IT added to implementation challenges for States with projects in this area. Nonetheless, some States successfully implemented focused IT applications.
Analysis of the projects implemented by the 14 demonstration States working in this area yielded the following insights:
- Developing effective communication pathways between practices’ EHRs and HIEs requires substantial resources dedicated to fixing interoperability problems, resolving privacy and other legal issues, and working closely with private IT vendors.
- Differences in EHR functionality, system incompatibility, and poor Internet connections made implementing QI projects challenging for some SBHCs. When these challenges can be overcome, SBHCs find it easier to collect and report data from their EHRs than from paper charts.
- In the process of working with contractors to develop an IT application, States must ensure that end users will actually use the application.
- Although the model EHR Format for children addresses many child-oriented functions, incorporating its requirements into current EHRs is likely to be challenging. Practice facilitators can help child-serving practices and health systems maximize the functionality of their EHRs. Getting EHR vendors to modify products to be more child-oriented, however, will continue to be very difficult because child-serving organizations represent a small share of EHR vendors’ business.
- Helping States use health IT to improve quality of care may require a separate demonstration program that assembles a higher level of technical assistance than is feasible in a multi-faceted grant program.
- Projects involving the development of electronic screening methods were able to achieve their objectives and showed that:
- Technology can streamline the administration of screening tools for health risks such as developmental delay or autism.
- The use of electronic screening tools in practices and SBHCs can enhance documentation that services were provided and can support data quality, tracking, and monitoring and a higher quality of care.
- Adolescents, families, and providers find electronic screening easy to use. Additionally, adolescents valued tablet-based screening as a way of communicating directly and privately with their clinicians.
Pennsylvania, in partnership with Children’s Hospital of Philadelphia and Geisinger Health System, implemented a fully electronic screening process for developmental disabilities and other conditions. This activity contributed to improved documentation of screening and laid a foundation for more consistent and rapid referrals to early intervention programs and other resources for children with positive screens. Providers reported that the screeners are useful, though some sites have been slower to integrate them than others because of EHR limitations and competing organizational priorities.
Utah and Idaho laid the ground work for an interstate HIE. The States initially planned to link their individual HIEs to share public health information, such as immunization data. However, Utah’s HIE development fell behind schedule as a result of vendor turnover, interoperability issues, and prolonged data sharing negotiations with provider groups. In addition, CHIPRA staff in Idaho had to work with the State’s legislature to overcome privacy-related legal challenges to interstate exchange. In spite of these challenges, Utah and Idaho remained committed to sharing data, so the States investigated alternative mechanisms. Ultimately, Utah was able to use direct file transfer to send records to Idaho for more than 10,000 Idaho children who had been immunized in Utah.
Practices’ use of a Vermont electronic registry was limited because many providers experienced difficulty in connecting their EHRs to the system, were concerned that the system required duplicative data entry, or both. In response, State-funded practice facilitators helped practices pull reports directly from practices’ EHRs.
Page originally created September 2015