A second round of preliminary findings from the American Academy of Family Physicians National Demonstration Project on the patient-centered medical home (PCMH) examines the use of healthcare information technology and chronic disease registries.

TransforMED, LLC, a wholly-owned subsidiary and redesign initiative of the AAFP, undertook the two-year pilot, which concluded in May 2008. The project included more than 36 practices across the nation and assessed the usefulness and impact on quality of care and business performance of the PCMH model.

A team of independent evaluators from The Center for Research in Family Medicine and Primary Care found that health information technology, such as EHRs, Web portals and chronic disease registries, can be implemented by a range of family practices, including small and rural practices.

Their findings included the following:

• Small, private practices were successful in implementing electronic health records.
• Rural practices were able to successfully implement a range of health information technology, including EHRs, patient portals and disease registries.
• Fourteen of the 31 practices successfully implemented patient Web portals, which enable patients to receive Internet-based services like secure e-visits and online lab results. Twelve of those 14 practices were small, private practices.
• Fifteen practices successfully implemented disease registries, 10 of which were small, private practices.
• While financial issues presented barriers, small practices needed assistance in making decisions about software capability and selecting an EHR and related technology.
• Some practices needed assistance in implementing an EHR and integrating new work processes into the practice routine. Nearly all of the NDP practices reported that implementing the EHR was more complicated and time-consuming than they anticipated.

"Small and/or rural practices may be better positioned to adopt technology because they are usually very nimble and self-sufficient," the evaluators said. "Also, the adoption of technology has usually been their own decision, not thrust upon them, so it is viewed as a personal investment. Because the private practices do not have the support system of a large system, the adoption of technology is viewed almost as a survival skill."

Evaluators also found that while chronic disease registries are beneficial, implementation is not easy. Their findings included:

• NDP practices found value in registries that allowed them to adopt a population-based, proactive approach to the management of prevention and chronic disease care.
• Those practices said disease registries provided opportunities to more fully engage practice staff in a more team-based approach to patient care.
• While most practices are eager to implement registries, few are willing or able to perform the "double data entry" required when EHRs will not support or populate a stand-alone registry.

"It should be noted that just having a registry in place – just the technology piece - does not guarantee effective population management," the evaluatoprs said. "This is because within the medical home concept, all the pieces are interdependent and interconnected, and the ability to use the registry effectively depends on many other pieces of the puzzle, especially the level of leadership, teamwork and communication within the practice."