A majority of physicians agree that the exchange of health information via electronic health record and health IT systems will improve the quality of care they provide to their patients, especially before and after transitions of care, according to a new survey from the Bipartisan Policy Center. “When well-designed and implemented, health information technology (IT) plays a critical and foundational role in improving the quality and cost-effectiveness of care,” note the authors of the survey. The successful design and implementation of these EHR and health IT systems, however, depends greatly on what and how physicians want to exchange.
Comprising response from more than 500 physicians, the survey focuses on capturing the needs and preferences of physicians concerning the use of electronic health information for transitions of care and making this feedback available to inform decision-making in the areas design and implementation. The 527 respondents work generally in primary care at private ambulatory care offices (49%) of less than 10 physicians, and a predominant percentage of them (71%) have been using an EHR system for 1–5 years (44%) or more (31%).
What the responses show is a general consensus among providers that electronic collaboration becomes increasingly as more and more patients move between a variety of providers and across a number of locations:
The electronic sharing of health information among clinicians is especially important during transitions in patient care, when responsibility for a patient’s care is “handed off” from one provider to another. This may happen when a patient is discharged from the hospital or when a primary care clinician refers a patient to a specialist for a specific health problem. When the treating physician receives appropriate, relevant, and timely information about a patient, he or she is better equipped to provide effective and efficient care.
As the authors note, primary care physicians treating Medicare patients on average work with 229 others physicians working in 117 different practices. Transitions of care, therefore, are not only a fundamental part of their care but also an opportunity for proper care to break down.
In terms of the benefits of electronic exchange, a vast majority of physicians agree that health IT systems have the greatest effect on the quality and coordination of care. Eighty percent of physicians (80%) agreed that these areas benefitted most from improvements to health information exchange. Intriguingly, incentive programs (e.g., EHR Incentive Programs) and reduced healthcare costs were lower on the list of positives, at 72% and 57% respectively. That’s not to say that these areas are unimportant or inconsequential, but that their importance pales in comparison to what’s essential to providers in caring for their patients.
Atop physicians’ concerns about barriers in the way of better exchange of health information are interoperability, infrastructure, and cost. The lack of interoperable EHR systems and capable infrastructure were neck in neck for the title of top major barrier at 71%. Cost was a close third at 69%. Surprisingly, data security, privacy, and integrity were minor barriers by comparison, 25%, 22%, and 8% respectively. It’s the exchange not the information itself that’s holding physicians back from collaborating more effectively.
When it comes to the types of information providers want to receive about their patients related to transitions of care, four predominate. The most essential are summaries of care or reasons for care, which eclipse 4.5 on of a 5-point scale. Next are laboratory tests results and radiology or imaging test results, which range between 4.25 and 4.5. Last is the medication list, which is most essential when patients are discharged from a hospital (more than 4.5) and slightly less essential before and after referrals (no less than 4).
The timely delivery of patient information is of major importance to physicians. For information deemed essential, a majority of clinicians (55%) want data pushed to them. Depending of the severity of a patient’s condition, the timing of this delivery varied. For patients requiring follow-up care after being discharged from a hospital, the largest number of physicians wanted pertinent patient data within 24 hours (nearly 50%) as compared to within 3 days for care not requiring follow-up (roughly 40%). For an urgent referral request, 60% of physicians want information immediately; for non-urgent conditions, clinicians are comfortable receiving information up to as many as three business days (roughly 70%).
When physicians receive information from external sources, most prefer the option to choose which pieces of data they want to integrate into their EHR system. Second to this majority of physicians (57%) are those who would integrate all information in their EHRs (16%). Unsurprisingly, physicians appear more confident in their own record keeping than those of their colleagues.
The development of state-level health information exchanges (HIEs) and planning for the Nationwide Health Information Network (NHIN) should be capable of improving exchange between providers. What’s still outstanding is the matter of cost. Who’s going to pay for these services and what will they cost?