Transforming the Office Management of Heart Failure using the Chronic Disease Model in a Residenc

Information Technology in PBRN PracticesSurvey vs. Site Visit

Donald E. Nease, Jr, Lee A. Green, Aartee Ignazcek, Patricia Watkins, John Calcagni, Gabe Thompson

University of MichiganDepartment of Family Medicine

Funded by: AHRQ R03 HS14413

why IT & PBRNs?

• practice electronic data

• demographics, diagnoses, services

• availability of internet access

• communication, distribution & return of study related information & materials

• collection of data via webPace WD, Staton EW. Electronic data collection options for practice-based

research networks. Ann Fam Med. 2005 May-Jun;3 Suppl 1:S21-9.

prior work• Andrews, et. al., 2004

• Kentucky Ambulatory Network (KAN)

• mailed survey of 68 office managers & 116 clinicians (46% & 51% resp. rate)

• 100% using electronic billing

• 50% have a LAN; internet in all but one

• 94% electronic scheduling

• 21% with an EMRAndrews JE, Pearce KA, Sydney C, Ireson C, Love M. Current state of information technology use in a

US primary care practice-based research network. Inform Prim Care. 2004;12(1):11-8.

GRIPSGRIN Research Infrastructure Practice Survey

• Aim: Conduct on-site detailed structural and functional assessments of GRIN practices focused on:

• current use of information systems

• billing

• electronic medical records

• reminder systems

• internet

methods

• Pre-visit survey - immediately prior to visit

• Visit

• Interviews with office manager, clinicians & staff

• Detailed observations

• Post-visit report

• Did we get it right?

GRIPS so far

• 33 surveyed & visited (target = 50)

• 85% have no academic affiliation

• Mean # physicians - 3.5 (2.8)

• Mean # extenders - 1.3 (0.9) among those who have them

results - connectivity

0%

25%

50%

75%

100%

survey visit3%

13%

97%87%

yes no

are your computers networked?

41%

59%

yes no

internet access at all workstations?

results - office systems

• 50% of those checking “no” on the survey actually do

• One practice that checked “yes” on the survey actually does not

0%

25%

50%

75%

100%

survey visit

13%17%

87%83%

yes no

do you utilize computerized billing?

results - office systems

0%

25%

50%

75%

100%

survey visit6%6%

94%94%

yes no

do you utilize computerized scheduling?

29%71%

yes no

computerized demographic reports?

results - office systems

0%

25%

50%

75%

100%

survey visit

70%73%

30%27%

yes no

do you utilize an EMR?

20%

80%

yes no

use an EMR beyond basic charting?

results - IT support

0%

25%

50%

75%

100%

survey visit

93%

67%

7%

33%

internal external

IT staff internal or external is IT support externally contracted?

42%

58%

yes no

conclusions

• GRIN PBRN practices visited so far...

• IT infrastructure limited to basic office systems

• may not be useful for enabling research

• Survey data alone may not give an accurate picture