Study: Gaps exist between gov't EMR expectations and clinician experiences
A gap exists between policy makers' expectations that current commercial EMRs can improve coordination of patient care and clinicians' real-world experiences with EMRs, according to a study conducted by the Center for Studying Health System Change (HSC) and published online Dec. 22, 2009, in the Journal of General Internal Medicine.
Ann S. O’Malley, MD, MPH, senior researcher at Washington, D.C.-based HSC, and colleagues examined 60 respondents through semi-structured telephone interviews in 12 randomly selected communities. The interviews were conducted to assess whether and how practices use commercial EMRs to support coordination tasks and identify alternatives practices have created to address new coordination challenges.
The respondents consisted of 52 physicians and other staff at 26 small and medium-sized physician practices with commercial ambulatory EMRs in place for at least two years, chief medical officers at four EMR vendors and four U.S. thought leaders active in health IT implementation.
Current commercial ambulatory care EMRs facilitate care coordination within a practice by making information available at the point of care but are less helpful for exchanging information across physician practices and care settings, according to the study supported by the New York City-based health research foundation Commonwealth Fund.
Other study findings included:
“Policymakers could expand current health IT policies to support assessment of how well the technology facilitates tasks necessary for coordination,” concluded the authors. “By reforming payment policy to included care coordination, policymakers could encourage the evolution of EMR technology in include capabilities that support coordination.”
Ann S. O’Malley, MD, MPH, senior researcher at Washington, D.C.-based HSC, and colleagues examined 60 respondents through semi-structured telephone interviews in 12 randomly selected communities. The interviews were conducted to assess whether and how practices use commercial EMRs to support coordination tasks and identify alternatives practices have created to address new coordination challenges.
The respondents consisted of 52 physicians and other staff at 26 small and medium-sized physician practices with commercial ambulatory EMRs in place for at least two years, chief medical officers at four EMR vendors and four U.S. thought leaders active in health IT implementation.
Current commercial ambulatory care EMRs facilitate care coordination within a practice by making information available at the point of care but are less helpful for exchanging information across physician practices and care settings, according to the study supported by the New York City-based health research foundation Commonwealth Fund.
Other study findings included:
- EMRs may have unintended consequences for care coordination, such as creating information overload that complicates providers' efforts to discern key clinical information.
- Clinicians believe current EMRs have limited ability to capture dynamic planning and the medical decision-making process in a way that supports future coordination needs.
- Maximizing the potential of an EMR for coordination involves ongoing evolution of clinical care processes as well as clinician input on EMR design modifications and standards for data exchange to support those processes.
- Modifying reimbursement to encourage coordination of care by clinicians will likely drive clinicians to demand better EMR functioning to support coordination.
- Simply creating incentives to adopt EMRs as they currently exist, given the confines of the current payment system, may result in EMRs being designed for billing purposes primarily rather than for clinical relevance to patients and care coordination.
“Policymakers could expand current health IT policies to support assessment of how well the technology facilitates tasks necessary for coordination,” concluded the authors. “By reforming payment policy to included care coordination, policymakers could encourage the evolution of EMR technology in include capabilities that support coordination.”