Electronic health record and primary care physician self-reported quality of care: a multilevel study in China

ABSTRACT

Background

Health information technology is one of the building blocks of a high-performing health system. However, the evidence regarding the influence of an electronic health record (EHR) on the quality of care remains mixed, especially in low- and middle-income countries.

Objective

This study examines the association between greater EHR functionality and primary care physician self-reported quality of care.

Methods

A total of 224 primary care physicians from 38 community health centres (CHCs) in four large Chinese cities participated in a cross-sectional survey to assess CHC care quality. Each CHC director scored their CHC’s EHR functionality on the availability of ten typical features covering health information, data, results management, patient access, and clinical decision support. Data analysis utilised hierarchical linear modelling.

Results

The availability of five EHR features was positively associated with physician self-reported clinical quality: share records online with providers outside the practice (β = 0.276, p = 0.04), access records online by the patient (β = 0.325, p = 0.04), alert provider of potential prescription problems (β = 0.353, p = 0.04), send the patient reminders for care (β = 0.419, p = 0.003), and list patients by diagnosis or health risk (β = 0.282, p = 0.04). However, no association was found between specific features availability or total features score and physician self-reported preventive quality.

Conclusions

This study provides evidence that the availability of EHR systems, and specific features of these systems, was positively associated with physician self-reported quality of care in these 38 CHCs. Future longitudinal studies focused on standardised quality metrics, and designed to control known confounding variables, will further inform quality improvement efforts in primary care.

KEYWORDS:

• Electronic health record
• quality of care
• health information technology
• primary care
• clinical quality

Responsible Editor Stig Wall

Responsible Editor Stig Wall

Acknowledgments

The authors would like to thank all the health bureau staff and participants involved in this study.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Author contributions

Wenhua Wang and Rebecca Mitchell designed the whole study. Mengyao Li and Jinnan Zhang analysed the data and interpreted the results. Wenhua Wang and Mengyao Li wrote the manuscript supported by Katya Loban, Xiaolin Wei, and Rebecca Mitchell. Wenhua Wang finally approved the version to be published. All authors read and contributed to the final version of this paper.

Ethics and consent

The ethical approval for this research was obtained from the Ethics Committee of Xi’an Jiaotong University.

Paper context

Electronic health records have been promoted as an important approach to improving the healthcare quality, while the effect of its features in primary care is not clear. We found that features such as sharing health information among different healthcare organisations, as well as providing patients access to their electronic health records, are positively associated with primary care quality. Future electronic health records improvement should focus on information exchange between different institutes and enhancing patient engagement.

Additional information

Funding

This work was supported by the National Natural Science Foundation of China [grant numbers 72004179].