America Makes Headway on Automating Health Care

Researchers Praise Progress, Point Out EHR Usability Issues

June 07, 2013 04:55 pm Sheri Porter

The task of automating America's health care system via physicians' use of electronic health record (EHR) technology is progressing but far from finished. That's the conclusion offered by authors of a new study(annals.org) in the June 4 issue of Annals of Internal Medicine.

According to the article, "Meeting Meaningful Use Criteria and Managing Patient Populations: A National Survey of Practicing Physicians," U.S. physicians are embracing EHRs in increasingly high numbers, but as recently as 2012, few physicians could meet the objectives set forth in stage one of the federal government's EHR meaningful use (MU) program.

In fact, of 1,820 primary care and subspecialty physicians in office-based practices who responded to the survey, 43.5 percent reported having a basic EHR, but only 9.8 percent said they had achieved MU. Fewer than half of the respondents said their EHR systems were capable of performing any of the patient population management tasks included in the survey.

Story Highlights
  • Researchers looking at use of electronic health records in the U.S. found that a good number of physicians have implemented basic systems, but few could meet stage one meaningful use standards.
  • Fewer than half of physicians surveyed could perform any of the patient population management tasks included in the survey.
  • Computerized functions for patient panel management and quality reporting were not widespread, and, when those functions were available, many physicians found them difficult to use.

The results didn't surprise study co-author Michael Painter, M.D., J.D., a family physician and senior program officer at the Robert Wood Johnson Foundation, which partnered with the Commonwealth Fund to fund the independent assessment of the nation's progress in adopting EHR technology.

"Transformation is incredibly hard, but our family docs -- and everybody else -- are doing a heroic job at adopting and then learning to use this new technology," said Painter.

EHRs are a tool that can be used to automate America's health care system -- an absolutely necessary process, according to Painter. Pulling an EHR out of a box is just the first step, said Painter. The real magic is in learning to use EHRs to perform key tasks, such as managing patient populations and generating quality metrics.

"Yes, we're having steady sustained increases in adoption, and that's exactly what we wanted to see," said Painter. "But what we really want is the transformation process."

Study Highlights

In addition to answering questions about national trends in EHR adoption and determining how many physicians were able to meet MU criteria, researchers also wanted to know which MU measures were most difficult for physicians to meet and whether physicians were able to use their EHRs to manage the health of their patient populations.

According to survey results, physicians most commonly used their EHRs to 

  • view lab results,
  • order prescriptions electronically,
  • view radiology and imaging results, and
  • record clinical notes.

On the other hand, physicians were least likely to use an EHR to

  • exchange patient clinical summaries and lab and diagnostic test results with clinicians outside the office,
  • generate quality metrics, and
  • provide patients with post-visit summaries and copies of their personal health information.

As for meeting MU criteria, 11.2 percent of primary care physicians had done so compared with just 7.6 percent of subspecialists.

Among primary care physicians, 40.5 percent had between eight and 10 MU functions available via their EHRs compared with 36.5 percent of subspecialists. Nearly equal proportions of primary care physicians and subspecialists reported having no MU functions (14.6 percent and 12 percent, respectively).

The authors noted that "computerized systems for patient panel management and quality reporting do not seem widespread, and, where they are implemented, physicians reported that they are not always easy to use." For example, fewer than half of physicians could generate lists of patients by diagnosis. Furthermore, only about one-third of physicians could

  • track referral completion,
  • generate reports on quality of care,
  • send patient reminders for preventive or follow-up care,
  • pull names of patients who missed appointments or were overdue for care,
  • create patient lists by lab results, and
  • provide patients with after-visit summaries.

Physician responses regarding ease of patient-management functions varied, but nearly half of physicians said they could not, or found it very or somewhat difficult to, perform many of the above functions.

Moving Forward

Researchers concluded that the study results held implications for federal policy, particularly in light of MU bonus payments doled out to more than 145,000 health care professionals and totaling more than $3.9 billion through September 2012.

"The pace of adoption of basic EHRs seems to be increasing, and findings around availability and perceived ease of use of systems that can help to manage patient populations should be of concern to policymakers," said the authors. "Using EHRs as simple replacements for the paper record will not result in the gains in quality and efficiency or the reduction in cost that EHRs have the potential to achieve."

However, Painter focused on the positive. He pointed out that although just 10 percent of physicians in the study had met MU criteria, "the number who are really close is really big -- almost 40 percent. It's 40 percent for primary care physicians and almost 40 percent of (sub)specialists, and that's a big deal."

In addition, Painter said he would expect that a good number of physicians would have "tipped over" into actually meeting the criteria if they were surveyed now. He predicted that when the already written and approved MU stage two rules take effect in mid-2014, physicians would "blow right past those because they're going to need -- and want -- to use those population tools and quality metric tools."

Painter, who saw patients in private practice from 1995 to 2003, urged his family physician colleagues to beat back discouragement. "It's really hard to practice primary care right now. It's slow going, but we are making progress," he said. "The best developers are going to try to develop things that physicians just love to use, but we're not there yet. We can't go back, because we can't get to where we need to be with health transformation without automating all these information processes."

However, physicians can help move things along by being very vocal with health information technology developers about what they need in EHR systems to get the greatest results possible, he added.


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