Health Affairs Study

Basic EHR Use Rising, but Data-sharing, Patient Engagement Lag Behind

August 22, 2014 08:51 am Michael Laff

Adoption of electronic health records (EHRs) among physicians in all specialties continues to increase steadily, and family physicians, in particular, are moving more advanced health information technology use.

[Female doctor typing on laptop]

The next stage, which entails sharing health information between institutions and engaging patients through technology, is proving more problematic, according to a new study.

Overall, only 40 percent of physicians reported having electronic exchanges of any sort with other providers, according to a study recently released online( and due to be published in the September issue of Health Affairs. To further break down the numbers, only one of seven physicians shared data with providers outside their organization. The authors cite privacy concerns and incompatible technology systems as the two primary reasons for the slow growth of information exchange.

Primary care physicians continue to lead their peers in EHR adoption, with 53 percent of primary care physicians using EHRs in 2013 compared to 43 percent of physicians in other specialties.

Use of EHRs is even higher among Academy members. According to the AAFP 2014 mid-year member census, 68 percent of respondents said they use EHRs, and only 17 percent said they do not. Twelve percent said they are in the process of implementing an EHR system.

Story highlights
  • Adoption of electronic health records (EHRs) among physicians in all specialties continues to increase steadily, with family physicians leading the way.
  • According to a recent Health Affairs study, however, health information exchange between institutions and engaging patients through technology are lagging behind.
  • A family physician expert notes that the current health care payment environment often works against adding advanced EHR functionality that would permit sharing of information.

"Family medicine is information-intensive, so that lends itself to tools that support that," said Steven Waldren, M.D., director of the AAFP's Alliance for eHealth Innovation. "Physicians in family medicine tend to be more comfortable with uncertainty, more entrepreneurial and more likely to be innovative."

However, a wider embrace of technology that allows physicians to communicate directly with patients has yet to occur, the Health Affairs study found. For example, only 30 percent of physicians reported using secure messaging to communicate with patients. And although 40 percent of physicians said their systems have the ability to allow patients to view, download or transmit information online, only half of those physicians said they were using that technology.

Patients who have chronic disease and elderly patients whose care is being managed remotely by their children are among individuals most likely to use patient portals. But according to Waldren, providing some kind of incentive for a wider range of patients to view or download the data continues to be a challenge.

"Patients with chronic disease or others who are engaged in their care will go in and make sure their data is correct," he said. "For a relatively healthy person who only has hypertension, there is not enough value to make it worthwhile to create an account and log in."

Waldren explained that meeting meaningful use stage one criteria associated with CMS' EHR incentive program refers to physicians who can provide basic technologically derived materials such as clinical summaries to patients for each visit. For stage two, criteria include being able to identify educational resources for specific conditions; exchange secure messages; and allow patients to view, transmit and download records online.

Furthermore, Waldren added, meaningful use stage two secure messaging criteria include a requirement that patients be able to initiate contact, and few are doing so -- either because they do not possess the technology or they encounter access problems tied to, for example, living in a rural area.

It comes down to hospitals and physician offices making the decision to invest in a basic EHR system and additional interfaces (plus potential connection fees) that allow them to be compatible. Then, both parties need to connect to a health information exchange or negotiate an agreement to share information. But building that kind of communication system requires a substantial financial investment and significant staff time, according to Waldren.

"Current health care payments create forces that often work against sharing of information and adding advanced functionality," he said.

Related AAFP News Coverage
EHR Meaningful Use Dropout Rate Soars in 2012
AAFP Works to Identify, Correct Barriers


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