Primary care physicians around the world have been investing in health information technology, a 10-country survey sponsored by the Commonwealth Fund has found. Changes in health system performance will be critical to healthcare reform, according to the findings published in Health Affairs.
Since 2009, utilization of electronic medical records has increased the most for physician practices in the U.S. (from 46% to 69%) and Canada (from 37% to 56%), based on survey responses. The highest level of utilization is in the Netherlands and Norway, both at 98%, followed by New Zealand and the U.K., both at 97%.
However, the electronic exchange of health information among healthcare providers is still not the norm in any country. New Zealand leads this initiative, with 55% of its primary care physicians reporting that they participated in health information exchanges (HIEs).
The 2012 survey was sent to nearly 8,500 primary care physicians and builds upon data acquired in a similar 2009 survey by the Commonwealth Fund, a private foundation focused on health policy headquartered in New York City. The survey focused on physicians' responses concerning patient access, satisfaction practicing medicine, communication across all sites of care, feedback on practice performance, and health IT capacity (Health Affairs, November 15, 2012).
Physicians polled worked in Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Switzerland, the U.K., and the U.S. Response rates ranged from 48% in the Netherlands to 20% in Germany, according to lead author Cathy Schoen, senior vice president of policy and research and evaluation, and colleagues at the Commonwealth Fund and Harris Interactive.
Health information technology
The survey included 15 questions about functions that healthcare IT systems potentially provide. The authors grouped electronic functions into several categories, which included generating patient information and patient registry information, order-entry management, and decision support.
Physician practices that said they used electronic medical records (EMRs) and at least two electronic functions in each of the categories were defined as having "multifunctional" health IT capacity. British physicians had the highest ranking in this category. The authors made a point of noting that nearly the same percentage of U.S. physicians (27%) as Dutch physicians (33%) were in this category in 2012, whereas in 2009, they were among the lowest ranked.
The size of a physician practice was a significant factor as to whether it had "multifunctional" health IT capacity. Practices with five or more physicians were significantly more likely to have this categorization in Australia, Canada, New Zealand, Switzerland, and the U.S. compared to a sole- or dual-physician practice.
Most physicians with EMRs reported the ability to generate patient and registry information. They also routinely use computerized physician order-entry (CPOE) systems for laboratory tests and prescription drugs. The authors did not specify if laboratory test orders included diagnostic imaging examinations. Utilization rates of decision-support systems were very low.
In Norway, 51% of physician practices offered their patients online ability to schedule appointments and request referrals to specialists. The U.K. followed at 40%, and the average was about 30% for physicians in other countries. Patients of physicians in the Netherlands, Norway, Switzerland, and the U.K. had a 50% chance of being able to refill prescriptions online. This dropped to about 30% in the other countries, with Australian and Canadian physicians reporting the lowest percentage.
Communication between patients and their primary physicians by email is on the rise. In Switzerland, more than two-thirds of respondents said they offered email access to their patients, followed by about half of the respondents from Germany and the Netherlands. The lowest users were from Canada, Australia, and Norway, respectively.
The capability offered by healthcare IT to enhance and expedite communications among healthcare professionals is desperately needed if healthcare reform is going to succeed. While more than half of the respondents in France and Switzerland said they always receive a report with relevant information after one of their patients is seen by a specialist, this dropped to less than 20% of respondents from the U.S. (19%), Germany (13%), and the Netherlands (13%).
Having access to or receiving information about patients in a timely manner was very low across all countries, with physicians from the Netherlands reporting that this occurred only 1% of the time. German and Norwegian physicians reported 4%. At 27% and 26%, respectively, Swiss and French physicians reported the greatest level of timely access to patients' records maintained by other healthcare providers.
Primary care physicians were equally uninformed about changes that specialists made to their patients' medications or care plans. With the exception of the Netherlands and New Zealand, fewer than half of primary physicians in any country were ever notified if their patients had been admitted to a hospital emergency department. Not unexpectedly, the majority of Dutch, New Zealand, and also Norwegian physicians had electronic access to hospital discharge summaries.
Physicians also reported delays from the time they ordered a specialized diagnostic procedure to the time a patient received it -- an issue that healthcare IT could potentially resolve through better scheduling and use of healthcare facility resources. While radiology was not specifically mentioned, more than half the doctors in Australia, Canada, France, Germany, New Zealand, and Norway reported that patients often faced long waiting times to see specialists and have diagnostic tests. In this survey, the top three countries with this problem were New Zealand, France, and Canada. This was also true for uninsured and Medicaid patients in the U.S.
"The redesign of primary care is central to reforms aimed at improving health system performance," the authors concluded. "Listening to doctors on the front lines of primary care can help identify gaps and target reforms of health systems."