Health Reform in Minnesota: An Analysis of Complementary Initiatives Implementing Electronic Health Record Technology and Care Coordination

Abstract

Background: Minnesota enacted legislation in 2007 that requires all health care providers in the state to implement an interoperable electronic health record (EHR) system by 2015. 100% of hospitals and 98% of clinics had adopted EHR systems by end of 2015. Minnesota’s 2008 health reform included a health care home (HCH) program, Minnesota’s patient centered medical home. By end of 2014, 43% of HCH eligible clinics were certified with 335 certified HCHs and 430 eligible but not certified clinics.Objectives: To study the association between adoption and use of EHRs in primary care clinics and HCH certification, including use of clinical decision support tools, patient registries, electronic exchange of patient information, and availability of patient portals.Methods: Study utilized data from the 2015 Minnesota Health Information Technology Clinic Survey conducted annually by the Minnesota Department of Health. The response rate was 80% with 1,181 of 1,473 Minnesota clinics, including 662 HCH eligible primary care clinics. The comparative analysis focused on certified HCHs (311) and eligible but not certified clinics (351).Results: HCH clinics utilized the various tools of EHR technology at a higher rate than non-HCH clinics. This better utilization was noted across a range of functionalities: clinical decision support, patient disease registries, EHR to support quality improvement, electronic exchange of summary care records and availability of patient portals. HCH certification was significant for clinical decision support tools, registries and quality improvement.Conclusions: The rapid uptake in EHR technology, combined with health reform efforts focusing on accountability and care coordination, pose opportunities and challenges for providers. Opportunities are availability of tools that support decision making, quality improvement and reporting. Challenges remain for clinics to optimize health information exchange. The need to meet various care coordination requirements were likely drivers for better EHR utilization by HCH clinics. This research presents the synergy between complementary initiatives supporting EHR adoption and HCH certification.