Technical barriers and costs are holding back electronic sharing of clinical data, according to the results of a recent survey conducted by a consortium of physician associations.
More than 70% of the physicians polled said that their electronic health record (EHR) system was unable to communicate electronically with other systems – a lack of interoperability that prevents electronic exchange of information. Another barrier is the cost of setting up and maintaining interfaces and exchanges to share information.
The survey findings are not surprising, Dr. Michael Barr, senior vice president in the division of medical practice, professionalism, and quality at the American College of Physicians, said during a forum sponsored by the Bipartisan Policy Center in Washington. They do, however, highlight the progress that physicians have made in embracing EHRs.
Several years ago, this type of survey might have shown that physicians wanted to keep the status quo or that they feared change, he said. Now, the barriers to exchanging information have more to do with technology than physician attitudes.
Making progress on interoperability will be essential as physicians move forward with different care delivery models such as the patient-centered medical home and the medical home neighborhood, which includes subspecialists, Dr. Barr said.
"The success of these new models will depend on health IT infrastructure that supports seamless coordination of care, patient engagement, and clinical information exchange," he said. "You can’t do team-based care unless everybody has access to the information appropriately."
Beyond interoperability, there are still challenges for physicians seeking to implement EHRs in their practices, said Dr. Robert M. Wah, immediate past chair of the board of trustees of the American Medical Association.
The money available through the Medicare and Medicaid Electronic Health Record Incentive Programs is beginning to change that equation, he said, but most physicians still say that the incentives offered aren’t sufficient to offset the loss in productivity, the change in their workflow, and the assorted other expenses of bringing on EHRs. "We’re still very concerned about that as a barrier," Dr. Wah said.
The physician survey was developed by the American College of Physicians and Doctors Helping Doctors Transform Health Care. The American College of Surgeons, the Association of Medical Directors of Information Systems, and the American Academy of Pediatrics also were involved with the survey. The groups circulated the survey to thousands of their members and received responses from more than 500 physicians.
About three-quarters of the respondents were using an EHR at the time of the survey, higher than the national average of about 55%, according to the National Center for Health Statistics. As a result, the survey developers cautioned that the results should not be used to reflect the view of U.S. physicians as a whole.
The respondents were mostly from small practices. Nearly three-quarters of the physicians surveyed worked in practices with 10 or fewer physicians and more than half were in practices of 5 or fewer physicians.
The survey also provides a more detailed picture of the type of EHR functionality that physicians say would help them better manage care transitions, such as when they refer a patient, when a patient is discharged from the hospital, and when a patient is referred by another physician. More than 80% of those surveyed said that medication lists, relevant laboratory test results, and results from relevant imaging tests were "very important" or "essential."
Physicians indicated that they wanted to have this type of essential patient data pushed to them, possibly though secure e-mail. They also wanted the ability to look up additional patient information in the electronic record.
The survey results could be helpful in accelerating the move toward interoperability in EHRs. A companion report from the Bipartisan Policy Center recommended that clinicians from across specialties and care settings develop a consensus on what types of clinical information should be shared, how they want to receive it, and reasonable timeframes for delivering the data. That consensus information could be used, along with technical standards, to help craft a national strategy for health IT interoperability, according to the report.