Primary care physicians in the United States and other countries are making inroads on health information technology use but continue to experience access-to-care barriers and breakdowns in coordination issues with other health care professionals, the Commonwealth Fund reported in a survey published online Nov. 15 in Health Affairs.

The survey polled nearly 8,500 primary care physicians in the U.S., Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Switzerland and the United Kingdom to gauge their health care experiences in the wake of new reforms taking effect in their countries. In tracking the technology investments, the survey found that doctors were making progress on health IT capacity, especially in the U.S.

A substantial increase was reported in the use and multifunctional capacity of health IT tools among U.S. primary care doctors over the past three years. For 2012, nearly 70% reported that they were using electronic health records, compared with 46% in 2009. “Although the United States and Canada still lag behind countries with near-universal adoption, the spread has been rapid in both countries, with a 50% increase in the rates of use of electronic medical records since 2009,” the survey stated.

Multifunctional IT use continues to progress more slowly in these two countries: Just 27% of U.S. doctors and 10% of Canadian practices reported having such capacities in their systems. Such use entails practices being able to manage patient registries, order diagnostic tests or prescriptions electronically, generate medication lists or other patient information, or send out alerts on drug interactions. Larger practices in the U.S. and at least four other countries were more likely to have multifunctional IT capacity than smaller practices.

A properly integrated EHR helps improve quality, decrease costs and assist with coordination, said Jeffrey Cain, MD, president of the American Academy of Family Physicians. Investing in this technology, however, requires time and money, and that’s a challenging prospect for primary care doctors who “are increasingly in a hand-to-mouth situation,” Dr. Cain said.

The U.S. and Canada have taken nationwide steps to boost health IT use, according to the Commonwealth Fund’s findings. In the U.S., the Centers for Medicare & Medicaid Services has been awarding meaningful use bonuses to physicians who adopt EHRs under a provision of the 2009 federal stimulus package.

Although the study said electronic access to records by patients is growing, primary care doctors in the surveyed countries have not made as much progress on exchanging information electronically with physicians outside of their practices. Switzerland, New Zealand and the Netherlands were ahead of other nations: Half of their doctors have this capability, compared with 31% of U.S. primary care physicians.

Doctors increasingly are becoming frustrated over the need for integration across systems, Dr. Cain said. “It’s wonderful when you have this for your own office and you can have better care with your pharmacy, but if you can’t talk to your hospital across the street or with a colleague who’s a specialist down the road, then you haven’t fully benefited from having an electronic health record. We as a country need to be able to move toward that.”

The American Medical Association, in partnership with AmericanEHR Partners, founded by the American College of Physicians, is surveying its members on what they like and don’t like about the EHR systems and vendors they use.

Doctors in the 10 countries reported to the Commonwealth Fund on other challenges related to teamwork and communication. A minority of primary care physicians reported always receiving timely post-referral information from specialists, and fewer than half said they always knew about medication or care plan changes by other doctors.

Long waits to see specialists also was a concern, with U.S. doctors in particular reporting problems with obtaining timely, consistent reports about their patients from hospitals and specialists. They also were the most likely to struggle with insurance restrictions and patients not receiving needed care because of cost issues.

Family physicians spend on average of eight hours per week dealing with administrative rules for insurance companies, Dr. Cain said. “To be truly efficient, it’s important to have integrated communication and systems.”

Patient safety concerns on Capitol Hill

Some U.S. lawmakers want more assurances from the federal government that health IT investments aren’t increasing patient safety risks. In 2011, the Institute of Medicine issued a cautionary report concluding that poorly designed systems could endanger patients and adversely affect the quality of care.

The IOM had recommended that the Dept. of Health and Human Services develop a plan to minimize health IT-related patient safety risks. In a Nov. 14 letter to HHS Secretary Kathleen Sebelius, Rep. Renee Ellmers (R, N.C.), who chairs the House Small Business subcommittee on health care and technology, said she had yet to receive a copy of this plan, despite repeated requests going back to June.

“Meanwhile, we continue to see media reports of patient safety risks related to health IT,” Ellmers wrote in her newest letter to Sebelius. A spokesman for the HHS Office of the National Coordinator for Health Information Technology said the office expected to issue its plan in response to the IOM report soon.

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