Few out-patient physicians have access to full-function EHR systems
Monday, June 23rd, 2008According to a summary report on a comprehensive national survey, more than eight out of 10 physicians practicing in an ambulatory setting have no access to any form of electronic health record (EHR), and only four in 100 have access to a full-function EHR system, despite four years of federal ballyhoo of health information technology (Modern Healthcare 6/18/08).
The report was funded by the Office of the National Coordinator for Health Information Technology in the U.S. Department of Health and Human Services, and the Robert Wood Johnson Foundation. Three authors receive support from GE Corporate Healthcare, and author and spokesman David Blumenthal, M.D., M.P.P, is an advisor to the presidential campaign of Barack Obama.
Given the low current availability of EHRs, “the U.S. healthcare system faces major challenges in taking full advantage of EHRs to realize its health goals” (ibid.).
The majority of physicians reported being satisfied with their EHRs (93% of the 117 with fully functional systems and 88% of the 2,160 with basic systems). The four possible responses, “very satisfied,” “somewhat satisfied,” “somewhat dissatisfied,” and “very dissatisfied” were combined into two categories, “satisfied” and “dissatisfied.” The possibility of a bias in the respondents, especially greater receptivity toward and facility with EHRs could not be excluded; the response rate was 62%.
Most of those with fully functional systems reported averting a known drug allergic reaction (80%) or a potentially dangerous drug interaction (71%), being alerted to a critical laboratory value (90%), ordering a critical laboratory test (68%), or providing preventive care (69%)—at least once.
Cost was the biggest barrier to adoption, the researchers concluded. “The cost of achieving widespread adoption of electronic health records in the United States could be high, probably in the tens or hundreds of billions of dollars” (DesRoches CM, et al. N Engl J Med 2008;359:50-60).
In its recent survey on Health Information Technology (HIT), AAPS included many of the items on the survey used by DesRoches et al. The AAPS survey asked about additional potential barriers, which proved to be just as important. Disruptions to practice were cited by 75%, third-party or government interference with decision-making by 77%, and potential linkage with pay for performance by 66%.
Concerns about how electronic technology could affect clinical reasoning are explored in a general way by Nicholas Carr in the July/August issue of Atlantic, “Is Google Making Us Stupid?”
The boon to thinking and research brought by the internet comes at a price. “As the media theorist Marshall McLuhan pointed out in the 1960s, media are not just passive channels of information. They supply the stuff of thought, but they also shape the process of thought.” Our ability to interpret text and make rich mental connections could suffer, as the brain reprograms itself in response to the new media, Carr suggests.
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