Assessment Of Variation In Electronic Health Record Capabilities And Reported Clinical Quality Performance In Ambulatory Care Clinics, 2014-2017

Question Is the adoption of more advanced electronic health record (EHR) capabilities associated with better ambulatory clinical quality of care? Findings In cross-sectional analyses of 3 states from 2014 to 2017, ambulatory clinics (769-972 per year) with more advanced EHR capabilities had higher scores on a composite measure of ambulatory clinical quality than did other clinics, which translated into an approximately 9% difference in rank order of quality. Across the much smaller number of clinics that gained advanced EHR capabilities between 2014 and 2017 (n = 72), the composite of ambulatory clinical quality improved more than for other clinics, but the difference was not statistically significant. Meaning This study suggests that ambulatory clinics with advanced EHR capabilities were associated with a better performance on a composite measure of ambulatory clinical quality than clinics with less-advanced EHR capabilities; clinics that adopted advanced EHR capabilities during a 3-year period were not associated with significant increases in ambulatory clinical quality performance.This cross-sectional study assesses the association between electronic health records with different degrees of capabilities and publicly reported ambulatory quality measures in at least 3 clinical domains of care.Importance Electronic health records (EHRs) are widely promoted to improve the quality of health care, but information about the association of multifunctional EHRs with broad measures of quality in ambulatory settings is scarce. Objective To assess the association between EHRs with different degrees of capabilities and publicly reported ambulatory quality measures in at least 3 clinical domains of care. Design, Setting, and Participants This cross-sectional and longitudinal study was conducted using survey responses from 1141 ambulatory clinics in Minnesota, Washington, and Wisconsin affiliated with a health system that responded to the Healthcare Information and Management Systems Society Annual Survey and reported performance measures in 2014 to 2017. Statistical analysis was performed from July 10, 2019, through February 26, 2021. Main Outcomes and Measures A composite measure of EHR capability that considered 50 EHR capabilities in 7 functional domains, grouped into the following ordered categories: no functional EHR, EHR underuser, EHR, neither underuser or superuser, EHR superuser; as well as a standardized composite of ambulatory clinical performance measures that included 3 to 25 individual measures (median, 13 individual measures). Results In 2014, 381 of 746 clinics (51%) were EHR superusers; this proportion increased in each subsequent year (457 of 846 clinics [54%] in 2015, 510 of 881 clinics [58%] in 2016, and 566 of 932 clinics [61%] in 2017). In each cross-sectional analysis year, EHR superusers had better clinical quality performance than other clinics (adjusted difference in score: 0.39 [95% CI, 0.12-0.65] in 2014; 0.29 [95% CI, -0.01 to 0.59] in 2015; 0.26 [95% CI, -0.05 to 0.56] in 2016; and 0.20 [95% CI, -0.04 to 0.45] in 2017). This difference in scores translates into an approximately 9% difference in a clinic's rank order in clinical quality. In longitudinal analyses, clinics that progressed to EHR superuser status had only slightly better gains in clinical quality between 2014 and 2017 compared with the gains in clinical quality of clinics that were static in terms of their EHR status (0.10 [95% CI, -0.13 to 0.32]). In an exploratory analysis, different types of EHR capability progressions had different degrees of associated improvements in ambulatory clinical quality (eg, progression from no functional EHR to a status short of superuser, 0.06 [95% CI, -0.40 to 0.52]; progression from EHR underuser to EHR superuser, 0.18 [95% CI, -0.14 to 0.50]). Conclusions and Relevance Between 2014 and 2017, ambulatory clinics in Minnesota, Washington, and Wisconsin with EHRs having greater capabilities had better composite measures of clinical quality than other clinics, but clinics that gained EHR capabilities during this time had smaller increases in clinical quality that were not statistically significant.