server and three workstations and to purchase patient education software. Software support costs approximately $350 per month. Local computer specialists charge $60/hour, for an average total cost of $4,000 per year. A part-time employee loads data on blood chemistries and scans incoming mail, radiology reports, and paper forms.

Performance measurement has been demonstrated for Dr. Wilson’s practice among patients with diabetes and cardiovascular disease. For example, the percentage of diabetic patients with hemoglobin A1c below 7 increased from 20 percent in 2002 to 55 percent in 2003. Patients suffering from coronary heart disease who received lipid-lowering medications increased from 66 percent in 2002 to 83 percent in 2003. Patients with coronary heart disease whose LDL cholesterol was measured increased from 42 percent in 1999 to 70 percent in 2000. Patients in the general population (not with a specific disease) with cholesterol measured in the past 5 years increased from 50 percent in 1999 to 65 percent in 2000. Key lessons learned from Dr. Wilson’s solo practice are summarized in Box C-3.

Case Study 3: Prime Care Family Practice

Prime Care Family Practice is a small internal medicine clinic located in Clinton, Oklahoma, that serves approximately 4,500 patients annually. The practice consists of one internist, a licensed practical nurse, and a medical technician. To improve their efficiency and track their patients’ chronic conditions, they adopted EHRs for their office 5 years ago. Prime Care works voluntarily with its state Quality Improvement Organization (QIO), Oklahoma Foundation for Medical Quality, to improve patient care.

Six years ago, Prime Care began its involvement in quality improvement by initiating data collection using paper-based records to qualify for a recognition program in diabetes care. Currently, the practice routinely submits Medicare administrative claims data tracking such measures as diabetes, mammography, adult immunizations, and cardiovascular disease. These performance data are collected annually by the Centers for Medicare and Medicaid Services, and subsequently reported to Prime Care by the state QIO. The QIO also helps Prime Care choose quality areas for improvement.

In addition, the Oklahoma Foundation for Medical Quality offers technical support to Prime Care through educational programs designed to improve internal quality by increasing work efficiency and to help the practice treat its diabetic patients more effectively. For example, all staff members at Prime Care attended several diabetes education programs with the QIO. The QIO does not charge Prime Care for technical or educational assistance designed to help improve work efficiency or diabetes care.

Prime Care has invested $30,000 in software and hardware over the past 3.5 years and pays a $350 per month maintenance charge for its Web-



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