Policymakers' expectations of how commercial ambulatory electronic health records can improve patient care coordination differ from health care providers' experience with such EHRs, according to a recent study by the Center for Studying Health System Change, Healthcare IT News reports.
The study, published online in the Journal of General Internal Medicine, was supported by the Commonwealth Fund (Ledue, Healthcare IT News, 12/30/09). For the study, researchers interviewed:
- 52 physicians and other staff members at 26 small- and medium-size physician practices with commercial ambulatory EHRs in place for at least two years;
- Chief medical officers at four EHR vendors; and
- Four national thought leaders active in health IT.
Study Findings
The study found that commercial ambulatory care EHRs can facilitate care coordination within a practice by making data available at the point of care but that the systems are less useful for exchanging information across different practices and health care settings (Lubell, Modern Healthcare, 12/29/09). The study also noted that there is a significant emphasis in commercial EHR design to support billing documentation rather than clinical management.
The study also found that:
- EHRs could have unintended consequences for care coordination, such as creating information overload that makes it difficult for health care providers to identify key clinical data;
- Given the U.S. health care payment system, EHR adoption incentives may lead to EHRs being designed primarily for billing purposes rather than for clinical and care coordination needs;
- Clinicians believe EHRs are limited in their ability to capture dynamic planning and the medical decision-making processes in a way that would support future care coordination needs;
- Ongoing evaluation of clinical care processes, as well as clinician input on EHR design modifications and standards for data exchange, are necessary to maximize the potential of EHRs to boost coordination; and
- If reimbursement was modified to encourage care coordination by clinicians, health care providers likely would demand better EHR function to support coordination (Healthcare IT News, 12/30/09).