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Improving EHR Adoption, Use through International Example

EHR adoption is high around the globe, but health information exchange and patient portal adoption are falling behind.

By Sara Heath

Physician-facing EHR adoption is thriving around the globe although health information exchange and patient portal adoption are low, according to a recent study in the Journal of the American Informatics Association.

The study was conducted as a part of the Organization for Economic Cooperation and Development’s information and communications technology (ICT) benchmarking pilot group. This group sought to assess how countries across the globe were adopting EHRs and other forms of health IT as a means to identify trends and contribute to benchmarks for adopting and implementing health IT.

The research team found that most countries had strong levels of EHR adoption, with most reaching at least 50 percent adoption. Twenty-nine out of the 38 countries included in the study had over 75 percent adoption.

The United States, recently touted by federal officials for its increasing levels EHR adoption, reported mature levels of adoption over 75 percent.

There were some differences in how providers from different countries utilized these tools. Some countries stored less data than others, while some had different functionalities.

The researchers saw more disparities when it came to health information exchange (HIE), finding that more countries had limited abilities in this area. Only 36 participating nations reported on this indicator, and only 12 of those 36 were able to report over 50 percent HIE. The researchers indicated that this may have been due to lacking interoperability between health information systems.

Canada and Finland were the outliers in this category, reporting either universal or near universal levels of HIE.

The researchers suggested this was due to their concentrated efforts toward specific HIE functions. In Canada, for example, health IT leaders implemented strategies to improve HIE of radiology images. Working toward excellence in that one area helped boost the country’s HIE as a whole.

The United States reported moderate HIE between 50 and 74 percent.

The researchers found similarly disparate results with regard to patient portal or personal health record adoption, with several countries reporting low levels of adoption.

In the United Kingdom and Denmark, the researchers found high levels of patient portals that have been tethered to primary care physician EHRs. The United States reported very low adoption of patient portals.

The researchers also noted that patient portal adoption is facing an upswing. Since the completion of their survey, many countries have increased their level of patient portal adoption.

As noted above, the researchers collected this data to help inform international benchmarks to improve the adoption and use of EHRs and health IT. While the data did inform the researchers of specific trends, they also noted the following issues which impact comparability in health IT adoption:

  • Linguistic differences and framing effects
  • Survey administration and data collection
  • Mapping from existing data sources
  • Health ICT architecture
  • Health system structures

However, the results still helped spark and international conversation to help improve health IT and EHR adoption.

“Pilot countries discussed why in some countries more progress had been made in acute care than in primary care while in others the reverse was true, what we could learn from countries that were supporting improved continuity of care through high levels of information exchange, and policy enablers and barriers to improving access to care via telehealth,” the researchers explained. “Likewise, many countries were able to draw conclusions from the results to inform national policy decisions.”

Going forward, the OECD will work to develop specific international health IT and EHR adoption benchmarks.

“The pilot will inform adaptation or deletion of questions based on field experience. Modules may also be added over time as technologies, usage practices, and policy interests change,” the researchers concluded. New topics are typically considered based on known policy needs and experiences of member countries with interest in those topics,” the researchers concluded.

“That said, an important consideration is to minimize the number and complexity of questions in recognition of the cost of collecting additional data, both in terms of resources required and respondent burden.”

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