EHR Use by Physicians Lagging

More than half of physicians regularly get patient information necessary to coordinate patient care from sources other than EHRs, a study finds.

Despite a federal mandate to adopt electronic health records systems, many physicians remain woefully behind in how they receive patient data, researchers say.

Published in the journal Medical Care, the study is the result of a collaboration by the Agency for Healthcare Research and Quality, the Office of the National Coordinator for Health Information Technology, and the National Center for Health Statistics. Researchers examined three sources of patient health information necessary for proper care coordination:

• Patient history and reason for referral to outside provider
• Consultation with an outside provider
• Hospital discharge information

The study found that more than half (54%) of physicians who regularly received information regarding care coordination did not receive that information electronically. While 64% of physicians surveyed said they routinely receive the results of a patient's consultation with a provider outside of their practice, they were often just as likely to receive the patient information through non-electronic means as they were a an electronic health IT system.

Researchers found that providers using EHRs were slightly more likely to receive these records in a timely manner and to use the information in a way beneficial to the patient than physicians who relied on fax, telephone, or photocopies as sources of patient information.

Nevertheless, the president-elect of the AMA blasted EHR systems last year, saying there is "a crying need" to make electronic health record systems "time-saving rather than efficiency-diminishing."

Q&A: ONC Deputy Nat'l Coordinator on EHR Usability

The barriers toward EHR adoption can feel intimidating to some physicians, explains Chun-Ju "Janey" Hsiao, PhD, MHS, a health services researcher at AHRQ, who served as the study's main coordinator and has compiled data on EHR adoption rates by physicians.

Cost Concerns
"The high costs associated with adoption and implementation historically have prevented the widespread adoption of EHRs," she says. "There is also a learning curve associated with using EHRs that often requires clinicians to change their workflow."

Even for physicians who are comfortable with the new technologies and willing to pay for them, the road toward integration hasn't always been straightforward, since most commercially available EHR systems are not interoperable—plus, practices and healthcare systems have had little incentive to make sharing patient data convenient, says Hsiao.

Interoperability
"When properly used, health information technology can enhance information sharing. However, if the EHRs do not 'talk' to each other, clinicians have to rely on manual means to share patient data," she continues.

Interoperability has long been an elusive goal of providers, payers, and technology vendors and was sure to be top of mind at ONC's annual meeting in Washington, D.C this week.

In October, the American Academy of Family Physicians, the American Medical Association, the Medical Group Management Association, the National Rural Health Association, and several large health systems submitted a letter to HHS Secretary Burwell, complaining that proprietary barriers, complex requirements, and an accelerated timetable put forward by HHS have made it difficult to realize interoperability.

Providers Ask HHS to Address EHR Interoperability Barriers

On Friday, ONC released draft 1.0 of the HIT interoperability roadmap based on months of input from HIT experts and policymakers. National Coordinator for HIT Karen DeSalvo, MD, pledged continued cooperation with "federal, state, and private sector partners to see that electronic health information is available when and where it matters."

Some physicians find the burden of EHR adoption heavier than others. Physicians in private practice or who work in community health centers have had a lower rate of adoption than physicians in hospitals or larger practices.

Additionally, says Hsiao, physicians in non-primary care specialties have a lower adoption rate than physicians in primary care specialties, as do physicians and practices in rural areas.

But Hsiao believes that change might be on the horizon. "A 10-year vision for a more interoperable health information technology infrastructure has been outlined," she says, which she hopes will help smooth adoption woes in the near future. When properly integrated, EHRs help ensure care coordination, says Hsiao—but it's up to each healthcare system and physician to make sure their patients are reaping the benefits of modern health IT.