Physicians struggle to get timely data, and patient care suffers
Despite widespread use of electronic health records, a recent survey has found gaps in how information flows between clinicians and also between physicians and their patients.
The survey, conducted by Nielsen Strategic Health Perspectives and sponsored by the Council of Accountable Physician Practices, reveals that health IT is coming up short in supporting the easy flow of information within healthcare, although some of the underlying reasons are not directly related to shortcomings of the technology.
The survey, which involved 30,000 consumers and 626 physicians, found significant gaps between what patients need and expect, and what clinicians are providing them with, including a lack of access and use of robust health information technology.
According to the survey, patient information is still not shared across providers. In fact, only 49 percent of physicians with EHRs said that they can share patients’ records electronically with clinicians outside their practice.
“This survey is evidence of the failure of American healthcare to provide coordinated, technologically enabled, high-quality healthcare to the majority of people,” said Robert Pearl, MD, chairman of the Council of Accountable Physician Practices. “Care has to be integrated. If physicians don’t work together as one, patients fall through the cracks. And they have to be able to put data into the electronic health record and be able to extract it out as one. If not, the patient information is incomplete.”
“We’ve made a lot of progress on EHR adoption—the numbers are pretty good—but in other areas, we haven’t made as much progress,” said Janet Marchibroda, director of the Health Innovation Initiative at the Bipartisan Policy Center, during a recent forum in Washington to discuss the survey results, presented by CAPP and BPC. “In order for coordination to happen, the members of the care team need to be able to communicate with each other. The numbers are still pretty poor—less than 50 percent.”
In addition, a mere 64 percent of surveyed doctors with EHRs reported that they receive information on hospital discharge summaries.
“When things fall through the cracks, errors occur and harm can occur—even death,” added Marc Klau, MD, assistant regional medical director of the Southern California Permanente Medical Group. “All of the transitions of care are key areas that really need to be tracked and make sure things don’t fall through the cracks.”
From the patient perspective, EHR systems have not been a technological panacea. Just 49 percent of consumers surveyed indicated that their physicians are able to share information about their health and know their medical history before they get to their appointment.
Further, only 60 percent reported that their primary doctor has access to any hospital or ER visit records without them bringing them to the physician office. And only 63 percent of surveyed consumers said that if their doctor is not available they could see another provider who has access to their EHRs.
Karen Cabell, chief of quality and patient safety at the Billings Clinic in Montana, agrees that having an integrated medical practice is critical in which all members of the healthcare team communicate and coordinate on behalf of patients.
“Having an integrated electronic health record is central to being able to deliver the right care for patients both at the point of care and outside via tools such as registries and other methods of looking at populations of patients,” said Cabell. “In order to deliver care to a population of patients, not just the one in front of you, you have to have the systems in place that can pull the information together and then have the people to use that information to act on it.”
However, according to the survey, patients with multiple chronic conditions—who would most benefit from care coordination—receive only slightly more follow-ups and care management as everyone else. The bottom line: coordination for those managing chronic illnesses, compared with those managing care for healthier patients, is not noticeably better.
When it comes to patient engagement, the survey also revealed that just 20 percent to 30 percent of consumers indicated that they have digital access to their provider through online submission of medical questions, email or text reminders. Nonetheless, about 42 percent to 48 percent of consumers reported access to online information, such as appointment scheduling, obtaining lab test results, or viewing information via patient portals.