Healthcare information technology is key to changing the model for primary care that is in place today, and for ultimately restoring health to a system that is on the verge of collapse, concludes a new report from the New England Healthcare Institute.

"Properly implemented, HIT frees up physician time during visits, provides all members of the primary care team with timely access to patient information and aids in the overall coordination of care," states the report "Remaking Primary Care: From Crisis to Opportunity."

The New England Healthcare Institute (NEHI) is a nonprofit, health policy organization focused on enabling innovation designed to improve healthcare quality and lower healthcare costs.

The report lists health information technologies as including electronic medical records, clinical decision support systems, computerized physician order entry (CPOE), online appointment scheduling, and secure messaging of test results.

"The implementation of these technologies does require substantial investment in both capital and personnel, the report notes. "Consequently, the development of financial models that encourage adoption and the creation of best practices in both implementation, use and maintenance of the systems are required."

Among other advantages, it notes, the use of information technology makes it possible for physicians to offer same day appointments, usually not available due to the limitations of the currents systems.

The report also urges reimbursement for phone and e-mail encounters. "Basic reimbursement for providers' time spent on phone and e-mail encounters with patients would be a major improvement to reimbursement policy," it states. "Many clinicians already provide these contacts without compensation, believing that they improve care and enhance patient experiences. Offering reimbursement for phone and e-mail activities is not only a matter of fairness, but will serve to support patient access and improve care continuity through communications mechanisms that are commonplace to most Americans."

As with any complex condition, the report notes, there is not one cause for the primary care system's ills, nor one cure.

Among the drivers of the crisis, according to the report:

• Demand: aging and chronic illness (The percentage of individuals aged 65 and older in the United States is expected to increase from 12.7 percent in 2008 to more than 20 percent in 2050).
• Supply: primary care workforce shortage;
• Drivers of shortage: income/reimbursement gap and increasing provider dissatisfaction with the work.

The report recommends changes in service delivery, site of care, workforce, reimbursement and medical education.

It also calls for improving pay-for-performance systems.

"The promise of primary care lies in improved health outcomes, yet financial incentives in the current system have been identified by experts as poorly aligned with quality goals." the report states. "Improved pay-for-performance would reward providers for helping their patients achieve positive health outcomes and move the system away from paying for episodic care. The reality of this new generation of pay-for-performance is complex; any system would need to fairly and transparently adjust payment according to case mix to prevent cherry-picking of healthy patients, and reward physicians who succeed with those patients in greatest need."