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Survey: Health IT use way up in U.S. primary care

Sunday November 18, 2012
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More than two-thirds of U.S. primary care physicians, 69%, reported using electronic medical records in 2012, up from 46% in 2009, according to findings from the 2012 Commonwealth Fund International Health Policy Survey.

Primary care physicians in the U.S., the only country in the 10-nation survey without universal health coverage, stood out for reporting in large numbers (59%) that their patients often cannot afford care. By comparison, between 4% and 25% of physicians reported problems affording care for their patients in Norway (4%), the United Kingdom, Switzerland, Germany and Australia.

Moreover, 52% of U.S. physicians said they spend substantial time grappling with insurance restrictions, by far the highest rate in the survey. U.S. physicians also were the most negative about their country’s health system, with only 15% agreeing the healthcare system works well.

The survey of nearly 8,500 primary care physicians in Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Switzerland, the United Kingdom and the U.S. found that communication and teamwork across the health system is a challenge in all countries. In each, only a minority of primary care doctors reported always receiving timely information from specialist physicians after referrals; in the U.S., only 11% of physicians said they had such information available when needed. From a third to more than half of doctors across countries said they are not always notified when their patients leave the hospital.

In the study, which appeared Nov. 15 on the website of Health Affairs, the U.S. stood out for having the lowest rates of after-hours care: a third (34%) of U.S. physicians reported they provided options for their patients to receive after-hours care, compared to 95% in the U.K., 94% in the Netherlands, 90% in New Zealand and 89% in Germany.

"The U.S. spends far more on medical care than the other countries we surveyed, yet our doctors are telling us their patients can’t afford care, they don’t always have the patient information they need, they spend too much time dealing with insurance companies, and we need major change," Cathy Schoen, the study’s lead author and senior vice president of the Comonwealth Fund, said in a news release.

"The insurance expansions under the Affordable Care Act will make care more affordable, but we also need to simplify insurance to free up physicians to provide timely access to high-quality care for their patients."

Use of health information technology

According to the survey, while the U.S. and Canada have made improvements in health information technology use, both countries continue to lag behind others in EMR use and the range of functions supported by practice systems. Only 27% of U.S. physicians and 10% of Canadian practices indicated their systems have multi-functional capacity, with the ability to generate patient information, such as medication lists; manage patient registries, such as learning which patients are overdue for care; order prescriptions or diagnostic tests electronically; and provide decision support, such as alerts about drug interactions.

In contrast, 68% of U.K. practices and 59% to 60% of New Zealand and Australian practices reported having such multifunctional capacity.

Providing patients with electronic access appears to be spreading. The survey found that 36% of U.S. physicians allow patients to request prescription refills online and 34% allow patients to email a medical question. Physicians in other countries also have expanded such electronic access; for example, 68% of Swiss doctors provide email access.

However, the ability of primary care physicians to exchange information electronically with doctors outside their practice is not routine in any country. New Zealand, the Netherlands and Switzerland lead on information exchange, with about half the doctors reporting having that capability, compared with 31% of physicians in the U.S.

"The substantial increase in U.S. doctors’ use of electronic medical record systems reflects the incentives and national investment included in the 2009 economic stimulus legislation," said Commonwealth Fund president Karen Davis. "As we look to the future, we hope to see similar progress as health reform provisions take hold, including patient-centered medical homes and healthcare systems that foster teamwork and coordination. With improvements in these areas, we will be able to improve patient outcomes and experiences, and make a positive difference for physicians."

Communication and teamwork

Primary care physicians’ reports on receiving information back from specialists and hospitals about care provided to their patients indicate that communication and teamwork are challenges shared by all the countries.

Only a minority of primary care doctors reported they always receive timely information from specialists after a referral (by country, the rates ranged from 1% to 27%), while less than half in any country said they always know about changes to their patients’ medications or care plans. A third to more than half of primary care physicians in all countries said they are not always notified when their patients are discharged from a hospital or seen in an ED.

U.S. doctors’ reports on receiving timely, consistent communications from specialists and hospitals generally were near the bottom of the country range.

To read the study, visit http://content.healthaffairs.org/content/early/2012/11/13/hlthaff.2012.0884.full.


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