Abstract
BACKGROUND
Policies promoting widespread adoption of electronic medical records (EMRs) are premised on the hope that they can improve the coordination of care. Yet little is known about whether and how physician practices use current EMRs to facilitate coordination.
OBJECTIVES
We examine whether and how practices use commercial EMRs to support coordination tasks and identify work-arounds practices have created to address new coordination challenges.
DESIGN, SETTING
Semi-structured telephone interviews in 12 randomly selected communities.
PARTICIPANTS
Sixty respondents, including 52 physicians or staff from 26 practices with commercial ambulatory care EMRs in place for at least 2 years, chief medical officers at four EMR vendors, and four national thought leaders.
RESULTS
Six major themes emerged: (1) EMRs facilitate within-office care coordination, chiefly by providing access to data during patient encounters and through electronic messaging; (2) EMRs are less able to support coordination between clinicians and settings, in part due to their design and a lack of standardization of key data elements required for information exchange; (3) managing information overflow from EMRs is a challenge for clinicians; (4) clinicians believe current EMRs cannot adequately capture the medical decision-making process and future care plans to support coordination; (5) realizing EMRs’ potential for facilitating coordination requires evolution of practice operational processes; (6) current fee-for-service reimbursement encourages EMR use for documentation of billable events (office visits, procedures) and not of care coordination (which is not a billable activity).
CONCLUSIONS
There is a gap between policy-makers’ expectation of, and clinical practitioners’ experience with, current electronic medical records’ ability to support coordination of care. Policymakers could expand current health information technology policies to support assessment of how well the technology facilitates tasks necessary for coordination. By reforming payment policy to include care coordination, policymakers could encourage the evolution of EMR technology to include capabilities that support coordination, for example, allowing for inter-practice data exchange and multi-provider clinical decision support.
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Acknowledgement
This study was supported by The Commonwealth Fund (grant 20070618). We are grateful to the numerous respondents who generously gave their time for interviews. We also thank the state and local physicians’ societies, the Massachusetts Medical Society and chapters of the American College of Physicians (ACP), the American Academy of Family Physicians (AAFP), the American Society of Clinical Oncologists (ASCO) and the American College of Cardiology (ACC) in the 12 communities for assistance in identifying practices with EMRs. Their input was invaluable. We also thank James E. Ward, Alwyn Cassil, Richard Baron and Peter Basch for their comments on an earlier version of this manuscript, as well as the anonymous reviewers.
Ann O’Malley had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
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None disclosed.
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All five authors are employees of the Center for Studying Health System Change, Washington, DC, 20024-2512.
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O’Malley, A.S., Grossman, J.M., Cohen, G.R. et al. Are Electronic Medical Records Helpful for Care Coordination? Experiences of Physician Practices. J GEN INTERN MED 25, 177–185 (2010). https://doi.org/10.1007/s11606-009-1195-2
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DOI: https://doi.org/10.1007/s11606-009-1195-2