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

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