Study Finds Gap Exists Between Technology Expectations, Reality

Interoperability, Care Coordination Issues Create Problems

February 16, 2010 02:50 pm News Staff

A recent study released by the Center for Studying Health System Change, or HSC, reveals a gap between what the federal government hopes health information technology, or health IT, can achieve in terms of patient care coordination and how well the technology actually assists physicians in practice.

"Are Electronic Medical Records (EMRs) Helpful for Care Coordination? Experiences of Physician Practices(," which was published online Dec. 22 in the Journal of General Internal Medicine, found that "there is a gap between policymakers' expectation of current EMRs' role in the coordination of care and clinicians' real-world experience with (these systems)."

The federal government currently is implementing a series of policies aimed at promoting the widespread adoption of electronic health records, or EHRs, and, according to the study, such "Health information technology has the potential to improve coordination by making information electronically available at the point of care, especially if implemented widely."

However, say the study authors, who are all HSC researchers, "little information exists on whether and how commercial EMRs are used to support care coordination." Most past research into the benefits of EHRs has focused on custom-built systems at large academic medical centers, say the authors.

For this study, the researchers conducted phone interviews and analyzed information gathered from 60 one-hour interviews with primary care physicians and subspecialists from 26 physician practices. Each of these practices had a commercially available EHR system in place for at least two years. Researchers also interviewed the chief medical officers for four EHR vendors and four national thought leaders in health IT.

Study Results

As a result of their qualitative research, the authors concluded that a highly functioning EHR should be able to

  • ensure continuity of care,
  • document and store patient information,
  • use information to manage and coordinate care,
  • initiate and track referrals and consultations,
  • enable health care sharing across practices and clinical settings, and
  • provide the exchange of information necessary for transitional and emergency patient care.

Notably, all of these tasks are required of physician practices desiring National Committee for Quality Assurance recognition as patient-centered medical homes.

The study authors said that small- and medium-sized physician practices generally agreed that their EHRs were useful in terms of making data available and coordinating patient care within their own practices. However, most physicians interviewed said their EHRs were less helpful when it came to exchanging information between practices and other health care settings because of a lack of interoperability between systems.

Study authors also found that EHRs had "unintended consequences for coordination, such as creating an information overload that complicated providers' efforts to discern key clinical information" within a patient's chart.

Clinicians in the study noted that current EHR systems do not adequately capture the medical decision-making process and future care plans to support care coordination. They also said that although EHRs have the potential to facilitate coordination of patient care, practice processes would have to change before that could happen.

Looking Forward

Researchers also found that the current fee-for-service reimbursement system encourages the use of EHRs for documentation of billable events, but care coordination is not considered a billable activity.

To address this problem, the study authors suggest that policymakers work on payment reforms to ensure that physicians receive payment for doing the work involved in care coordination. Doing so would "encourage the evolution of EMR technology" to allow for completion of such tasks as interpractice data exchange and clinical decision support among multiple providers.

The authors also suggest that the government create additional health IT policies aimed at funding more studies to learn how well physicians' EHR systems perform the kinds of tasks necessary to achieve care coordination.

The study notes that the federal government continues to embrace patient-centered medical homes through its investments in primary care. By definition, medical homes provide patients with accessible, continuous and comprehensive care, but according to the report, "study participants found EMR support for these activities to be suboptimal."

The authors conclude that new funding for EHR adoption and the ongoing work on standards for data exchanges "need to be accompanied by more attention to re-engineering EMRs and health IT so that they better support the coordination of care."