Health Information Systems in Small Practices Improving the Delivery of Clinical Preventive Services Sarah C. Shih, MPH, Colleen M. McCullough, BA, Jason J. Wang, PhD, Jesse Singer, DO, MPH, Amanda S. Parsons, MD, MBA Background: Despite strong evidence that clinical preventive services (CPS) reduce morbidity and mortality, CPS performance has not improved in adult primary care. In addition to implementing electronic health records (EHRs), key factors for improving CPS include providing actionable information at the point of care, technical support staff, and quality-improvement assistance. These resources are not typically available in small practices. Purpose: Estimate the impact on CPS delivery after a software upgrade to embed a clinical decision support system and practice-level quality-improvement support services. Methods: Practices were recruited from the Primary Care Information Project, a citywide initiative assisting practices adopt health information technology. Data were collected in 2009 and 2010, and analyses were conducted in 2010 and 2011. Across two time periods, receipt of CPS was calculated for 56 practices. Period 1 measured CPS delivery 2–37 months following implementation of an EHR. Period 2 measured CPS delivery within the fırst 6 months after an EHR software upgrade. Results: Substantial increases in the delivery of selected CPS were observed after the EHR software upgrades. Blood pressure control for patients with hypertension increased from 46.0% to 54.8%. Breast cancer screening, recorded BMI, and HbA1c testing for patients with diabetes also increased. More than half of the practices increased their patients’ blood pressure control, recorded BMI, breast cancer screening, and HbA1c screening by 5 percentage points. Conclusions: Delivery of CPS can increase in small primary care practices that implement an EHR that includes comprehensive quality-improvement support. (Am J Prev Med 2011;41(6):603– 609) Published by Elsevier Inc. on behalf of American Journal of Preventive Medicine Introduction C linical preventive services (CPS) have been shown to have a substantial impact in reducing prevent- able deaths. 1 Yet, these services are not delivered consistently, and national trends have not increased ap- preciably in the past decade since McGlynn and col- leagues 2 estimated that adults receive 50% of the recom- mended preventive care. 3 Barriers reported in the literature 4–6 include limited time during the patient visit, lack of suffıcient reimbursement, particularly in compar- ison to payments for treating the ensuing disease, as well as lack of access to robust information systems that en- able point-of-care clinical decision support and action- able, patient-specifıc information at time of visit. However, improvements in CPS delivery have been reported in large healthcare organizations. In addition to implementing health information systems, large organi- zations have provided technical support for practice workflow redesign and training, employed shared re- sources, and instituted payment structures that reward prevention in addition to treatment. 7,8 Although large health systems are able to establish broad-based systems to increase CPS delivery, 9 –12 attempts to replicate similar initiatives have been challenging in fragmented, multiple- payer settings lacking central coordination of resources, alignment of incentives, and organized deployment of health information technology (HIT). Health systems and trained technical support staff are unlikely to be available to small practices without substantial fınancial burden. From the Primary Care Information Project, New York City Department of Health and Mental Hygiene, New York, New York Address correspondence to: Sarah C. Shih, MPH, Department of Health and Mental Hygiene, Primary Care Information Project, 42-09 28th Street, 12th Floor, Queens NY 11101-4132. E-mail: sshih@health.nyc.gov. 0749-3797/$36.00 doi: 10.1016/j.amepre.2011.07.024 Published by Elsevier Inc. on behalf of American Journal of Preventive Medicine Am J Prev Med 2011;41(6):603– 609 603