U.S. primary care doctors showing progress in EMR use, still struggle with access to care

A new report indicates that while U.S. primary care physicians still trail their counterparts in other countries in their use of electronic medical records (EMRs), they are making progress and are finding more efficiencies through EMR use.

According to the recently-released 2012 Commonwealth Fund International Health Policy Survey published in Health Affairs, two-thirds (69 percent) of primary care physicians in the U.S. reported using EMRs in 2012, up from less than half (46 percent) in 2009. In some countries, such as the Netherlands, New Zealand, Norway and the United Kingdom, nearly 100 percent of primary care physicians have been using EMRs since at least 2009.

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"I think we're seeing a success story in the U.S. when it comes to EMRs, which is very exciting," said Robin Osborn, one of the study's authors and vice president and director of The Commonwealth Fund's International Program in Health Policy and Innovation. "The very thoughtful and well-designed strategies that came out of the high-tech act in the stimulus bill – it really has the kind of technical assistance and standards that have all enabled the majority of doctors to get more up to speed with EMRs, which is really exciting because we are closing the gap with other countries where virtually 100 percent have had EMRs for 10 years or more."

Financially, this is good news for the U.S. healthcare system due to increased efficiencies, said Osborn.

"The expectation is that having a lot of the data electronically and being able to share it easily will produce efficiencies. If you have information about a test a patient already had, there is less duplicative testing," she said. "It's an investment up front, but the really smart systems also have clinical decision support as well, which includes reminders for doctors of tests patients should have or recommendations of what drugs to order for patients and what a less expensive option might be."

The survey also noted that while things like EMR use are creating efficiencies, including cost efficiencies, there are still challenges.

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For example, the U.S. is still struggling when it comes to having affordable care for patients, noted the survey. In the U.S., which is the only country in the survey without universal health coverage, 59 percent of physicians said their patients often have trouble paying for care. This compares to the rates in other countries with Norway at 4 percent, the United Kingdom at 13 percent, Switzerland at 16 percent, Germany at 21 percent and Australia at 25 percent.

In addition, more than half (52 percent) of U.S. doctors said they or their staff spend too much time dealing with insurers' restrictions on covered treatments or medications, which is by far the highest rate in the survey.

According to Osborn, the ability to exchange information electronically between all caregivers is a struggle in all of the countries surveyed. In each country, only a minority of primary care doctors reported always receiving timely information from specialists to whom they have referred patients, while less than half said they always know about changes to their patients' medications or care plans.

"This information flow about patients and the information not following a patient is really a challenge and one thing we are hopeful will become more addressed and solved in the coming years," said Osborn.

Osborn added that national policies related to insurance design, support for primary care practices and healthcare IT can improve efficiencies and access to care for patients a great deal. For instance, all of the study countries, except the U.S. and Canada, have policies for ensuring patient access to primary care outside of regular office hours, which range from the establishment of walk-in centers and national help lines in the United Kingdom, to physician payment incentives in Australia.


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