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Electronic Medical Records and Health Information Technology

Linda Lambert, CAE, Babette Peach

Health Information Technology

Healthcare experts, policymakers, payors, and consumers consider health information technology to be an essential element in transforming the healthcare industry. Given the current fragmented nature of health care, the need to integrate new scientific evidence into the practice of medicine, the emergence of telemedicine activities including secure messaging and eVisits, and the importance of practice transformation to achieve improved health outcomes, paper-based systems are becoming obsolete. In theory, the benefits of health IT are evident; however adopting these technologies has been difficult and slow. In January 2009, President-elect Barack Obama called for all U.S. residents to have electronic health records within five years and that he would seek allocations of $50 billion over five years to support the adoption of standards-based health IT systems and interoperable national health information network.1

Trends:

• The federal government will continue to expand the Office of the National Coordinator for Health Information Technology (ONCHIT) and agencies such as eHealth Initiative (eHI) will form multi-stakeholder collaborative to promote use of Health IT and Electronic Medical Records.
  
  
• Growth will be progressive – taking steps to adopt segments of HIT such as e-prescribing and expanding to full electronic medical records.
  
  
• Physicians will use point of service IT to most efficiently serve their patients.
  
  
• States will seek to fill the gap of implementation as they see the benefits.
  
  
• Payors and hospital systems will offer opportunities to implement various phases of HIT in physician practices in exchange for expectation of more efficient claims filing and to collect data not only to determine the level of services performed but to assess the quality of services delivered and their adherence to standardized practice measures.

Electronic Health Records

Electronic health records have the potential to improve the delivery of health care services. However, in the United States, physicians have been slow to adopt such systems. A national study released in June 2008 by the New England Journal of Medicine assessed physicians' adoption of outpatient electronic health records, their satisfaction with such systems, the perceived effect of the systems on the quality of care, and the perceived barriers to adoption and confirms previous research:

Respondents:

• Four percent of respondents reported having a fully functional* electronic-records system, 13% reported having a basic system.
  
  
• Of the small number of respondents who had a fully functional system, 71% reported that their system was integrated with the electronic system at the hospital where they admit patients, as compared with only 56% of respondents with a basic system.
  
  
• Among the 83% of respondents who did not have electronic health records, 16% reported that their practice had purchased but not yet implemented such a system at the time of the survey. Additionally 26% of respondents said that their practice intended to purchase an electronic-records system within the next 2 years.
  
  
• Physicians who practice in groups of more than 50 were three times as likely to have a basic electronic-records system and more than four times as likely to have a fully functional electronic-records system as were physicians in groups of 3 or fewer. However, even in large groups, only a small minority (17%) had a fully functional system, and 49% had no electronic-records system at all.
  
  
• Electronic-records systems were more prevalent among physicians who were younger, worked in large or primary care practices, worked in hospitals or medical centers, and lived in the western region of the United States.
  
  
• Rates of adoption did not differ significantly among providers serving a high proportion of minority patients or patients who were uninsured or receiving Medicaid, as compared with other physicians.
  
  
• Among the 17% of doctors with a fully functional or basic electronic-records system, at least 97% reported using all the functions at least some of the time.
  
  
• Among the small number of respondents who had fully functional electronic-records systems, most physicians reported the positive effects of the system on the quality of clinical decisions (82%), communication with other providers (92%) and patients (72%), prescription refills (95%), timely access to medical records (97%), and avoidance of medication errors (86%).
  
  
• Furthermore, 82 to 85% reported a positive effect on the delivery of long-term and preventive care that meets guidelines. For physicians with basic systems, the extent of positive effects was generally smaller.
  
  
• Most of those with fully functional systems reported averting a known drug allergic reaction (80%) or a potentially dangerous drug interaction (71%), being alerted to a critical laboratory value (90%), ordering a critical laboratory test (68%), and providing preventive care (69%).
  
  
• Ninety-three percent of physicians with fully functional systems reported being satisfied with their electronic-records systems overall. 88% of physicians with basic systems reported being satisfied with their electronic-records systems overall.
  
  
• Eighty-eight percent of physicians with fully functional systems reported an ease of use of the system when providing care to patients. Eighty-one percent of physicians with basic systems reported an ease of use of the system when providing care to patients.
  
  
• Ninety percent of physicians with fully functional electronic-records systems were significantly more likely to be satisfied with the reliability of their system than 79% of those with basic systems.
  
  
• Among physicians who did not have access to an electronic-records system, the most commonly cited barriers to adoption were capital costs (66%), not finding a system that met their needs (54%), uncertainty about their return on the investment (50%), and concern that a system would become obsolete (44%).
  
  
• Factors that were most frequently cited as facilitators of adoption were: financial incentives for the purchase (Fifty-five percent among physicians with no electronic health records and 46% among those with electronic health records); and payment for use of an electronic-records system (57% and 52%, respectively).
  
  
• About 40% of respondents with and without an electronic-records system also reported that protecting physicians from personal liability for record tampering by external parties could be a major facilitator of adoption.
  

1ABC News Medical Unit, President-Elect Urges Electronic Medical Records in 5 Years, January 09,
   http://abcnews.go.com/Health/President44/Story?id=6606536&page=1