High-intensity technical assistance might be key to realizing quality gains from the use of electronic health-record systems among small-practice doctors caring for patients in underserved areas, a new study suggests.

The study, published in Health Affairs and undertaken by researchers from Weill Cornell Medical College and the Primary Care Information Project of the New York City Health Department, found that EHR implementation alone was not enough to improve the quality of care provided by the primary-care physicians studied, who worked in small practices in underserved neighborhoods in New York. Physicians receiving assistance from the Primary Care Information Project scored higher on selected quality measures than physicians not receiving the assistance. The Primary Care Information Project provided subsidized EHR software, clinical-decision support and onsite technical assistance to about 3,300 physicians at roughly 600 primary-care practices, according to a Weill Cornell news release.

The results may prove useful for federal regional extension centers charged with helping providers in their adoption of EHRs as the centers decide how and where to allocate resources, said Andrew Ryan, assistant professor of public health at Weill Cornell and the study's lead author. The extension centers were created to assist with the EHR incentive payments instituted as part of the American Recovery and Reinvestment Act of 2009.

Ryan said the study did not look at the cost-effectiveness of the high-intensity assistance, though that could be fodder for future research. "Is that (level of assistance) really worth it?" Ryan asked.