North Carolina and Pennsylvania are testing the new Children’s EHR Format as part of the Children’s Health Insurance Program Reauthorization Act (CHIPRA) Quality Demonstration Grant Program.
With funding from CMS starting in 2010, the Agency for Healthcare Research and Quality www.ahrq.gov is leading the national evaluation for the demonstrations which is expected to be completed by September 2015.
To initiate the grant program, CMS awarded 10 grants to 18 states to improve the quality of healthcare for children enrolled in Medicaid and the Children’s Health Insurance Program (CHIP).
The 18 states with ongoing demonstrations have implemented 52 projects in five general categories to study how quality measures can improve children’s healthcare, applying health IT for quality improvement, implementing provider-based delivery models, investigating a model format for pediatric EHRs, and assessing other innovative approaches to improve quality.
To provide information on the demonstrations, in August, AHRQ published their Evaluation Highlight No.10, titled “The National Evaluation of the CHIPRA Quality Demonstration Grant Program”.
The Evaluation discusses how North Carolina and Pennsylvania progressed after joining the Demonstration Program. The two states joined because they were dissatisfied with their EHRs capacity for supporting high quality children’s healthcare and for the opportunity to improve their EHRs or both.
State and provider stakeholders in North Carolina and Pennsylvania have agreed that the EHR Format does address many child-specific functions not addressed by current EHRs. Looking at it from a practical viewpoint, practices and health systems discovered that their EHRs did not meet many EHR Format requirements although some requirements were available through the purchase of an EHR upgrade.
To find out information on the topic, the two states took different approaches to testing the usability and functionality of the EHR Format. Pennsylvania tested it with five health systems serving children that included three children’s hospitals and affiliated ambulatory practice sites, one FQHC, and one small hospital.
Pennsylvania gave the five health systems freedom to test the EHR Format as they saw fit and designated one of the children’s hospitals to support and loosely organize the work of the other four systems.
North Carolina hired EHR coaches to recruit practices in an assigned area of the State to test the EHR Format. Coaches oversaw the completion of a survey that asked practices and vendors to compare existing EHRs to the Format.
Both states discovered that the process of comparing the EHR Format to existing EHRs was time consuming. As they prioritized the EHR Format requirements and staff training needs, the health systems and practices confronted the limits of their health IT resources and their leverage with EHR vendors.
State health system and practice staff in North Carolina and Pennsylvania have reported that EHR vendors were reluctant to engage in their demonstration projects because of other priorities. It was also suggested that independent practices and health systems that use the same EHR product could consider approaching EHR vendors together to increase their negotiating strength.
It was also thought that the Federal government could motivate EHR vendors to create products to meet the requirement of the EHR Format by developing an EHR certification module for child health that in turn, could create a market for certified child-oriented EHRs. Depending on AHRQ’s and CMS enhancements to the EHR Format, it may be desirable to develop more than one module, including one for a core or minimum set of requirements.
Go to www.ahrq.gov/policymakers/chipra/demoeval/what-we-learned/highlight1.0.pdf to view Evaluation Highlight No. 10 august 2014 titled “How are CHIPRA Quality Demonstration States Testing the Children’s EHR Format?”