The HITECH Act laid out a broad and ambitious approach to encourage providers to adopt and use health IT in ways that are expected to improve the quality, safety and efficiency of care. The centerpiece is financial incentives for providers who implement electronic health records (EHRs) and use them in accordance with federally specified meaningful use criteria. Criteria that promote care coordination are heavily emphasized because of the potential for EHRs, coupled with electronic health information exchange (HIE), to enable patients'health information to follow them between delivery settings. Care coordination criteria focus on summary care record exchange and reconciliation of medications, medication allergies, and problems. These criteria were, however, largely deferred to later stages of meaningful use because of the unique challenges they pose: providers need to learn how to use EHRs to generate key pieces of information that should follow patients between settings;(2) providers need the capability to engage in HIE;and (3) providers need to become accustomed to receiving and incorporating data from other settings into clinical decisions. Most providers have little experience exchanging or using electronically shared clinical data, limiting our understanding of how to ensure that the national investment in health IT results in more coordinated care. Our project, developed in response to Special Emphasis Notice NOT-HS-13-006, will generate evidence on current readiness to meet proposed Stage 3 care coordination criteria in primary care practices and, given the gaps we find, identify the underlying barriers and facilitators that enable criteria achievement. Our project will also assess whether criteria achievement improves care coordination, and identify practice-led and policy-driven strategies that increase the extent to which EHR use results in well- coordinated care. To achieve these aims, we will conduct a mixed-methods study that includes (1) a statewide survey of primary care practices in Michigan that have attested to Stage 1 meaningful use, complemented by (2) qualitative and quantitative analyses of the experience implementing Stage 3 care coordination measures, and perceived impact on care coordination, in 15 primary care practices. Our findings will help ensure that final Stage 3 care coordination criteria are evidence-based, and set targets that are both achievable and result in substantial gains. They will also guide practices on optimal strategies for using EHRs to improve care coordination.

Public Health Relevance

Without a clear understanding of what enables practices to successfully use EHRs to support care coordination and meet the related federal meaningful use criteria, the goals of the HITECH Act, to use IT to improve the quality and efficiency of care, will not be realized. In addition, broader efforts to leverage EHRs for population health and public health aims will be impeded.

National Institute of Health (NIH)
Agency for Healthcare Research and Quality (AHRQ)
Research Demonstration and Dissemination Projects (R18)
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Health Care Technology and Decision Science (HTDS)
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White, Jon
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University of Michigan Ann Arbor
Other Domestic Higher Education
Ann Arbor
United States
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