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Despite Recent Progress, U.S. Use of Health IT Lags Behind Some Other Countries, Commonwealth Fund Says

By Caitlin McGlade, CQ Staff

November 15, 2012 -- While more primary care doctors are adapting to health information technology to track medical records, they're still having trouble syncing with specialists or hospital personnel to get the full picture of their patients' care, according to a recent Commonwealth Fund survey.

The survey compared 10 countries' health systems in terms of patient access, health information technology use, communication, performance and satisfaction with the medical system. Published in the December edition of Health Affairs, the survey asked about 8,500 primary care doctors about their perceptions and experiences.

"Simply put, we don't communicate well in any country in terms of patient flow—it's not patient-centered and it's a challenge," Cathy Schoen, senior vice president of policy, research and evaluation at the Commonwealth Fund, said during a teleconference.

Fewer than 20 percent of doctors in Germany, the Netherlands and the United States said they always received reports from the specialists who saw or treated their patients. More than half of the doctors surveyed in France and Switzerland typically received such reports. Many are still using mail or fax to receive reports, which stalls the treatment process, said Robin Osborn, vice president and director for the Commonwealth Fund's International Program in Health Policy and Innovation.

Using electronic medical records can move communication forward, Schoen said.

As with most other facets of the study, the main difference dividing more frequent use of health information technology and more sparse use depended upon whether the countries had national policies guiding doctors. Ninety-seven percent of doctors in the United Kingdom and New Zealand reported using electronic medical records. Both countries have had electronic medical record policies for years.

The United States is catching up. Sixty-nine percent of the U.S. doctors surveyed reported using electronic medical records compared to 46 percent in 2009. The survey's researchers pointed to a portion of the stimulus package (PL 111–5) as a driving mechanism for the change. The 2009 law allocated $19.2 billion to jump-start the use of electronic medical records, setting up financial incentives for hospitals and doctors to use such systems. And it set aside billions of dollars to create and maintain the necessary infrastructure as well as millions of dollars for research.

Referencing a similar Commonwealth Fund study conducted in 2006, Fund President Karen Davis said the team found that establishing national standards for an electronic medical record system was one of the keys to bringing a country's whole health system on board. Otherwise, individual practices may be reluctant to buy an expensive system, which may or may not become outdated within a few years. The second and third keys included financial incentives and funding and the creation of a health information exchange portal, Davis said.

The issue of interoperability and cost was raised at a House hearing on Health IT.

Davis said she also sees in the near future more primary care doctors teleconferencing with specialists during an appointment with their patient, to answer specific questions immediately.

"For the first time there is the technical capacity when you've done a test to digitally share the results of the test so the next doctor can see the results. Before it required either paperwork or a phone call," Schoen added. "We can, in a virtually connected way, start having practices that were silos before connect each other."

The study found a number of other differences among medical systems that deviated along national policy lines. The United States and Canada ranked the lowest in the study for after-hours care arranged by primary care doctors. Patients in these countries are also more likely to use emergency departments. The U.S. and Canada are the only two out of the 10 without policies about after-hours coverage. Policies in other countries include physician-run cooperatives in the Netherlands, walk-in centers and national help lines in the United Kingdom and payment incentives for physicians who provide after-hours coverage in Australia, according to the report.

The U.S. also ranked the highest in payment problems—59 percent of the doctors reported that their patients often had difficulty paying for care, followed by 42 percent in the Netherlands and 29 percent in France. A little more than half of the U.S. doctors considered the amount of time they spend dealing with insurance coverage a "major concern," compared to 37 percent in Germany and 26 percent in the Netherlands.

The report concludes that the federal health care overhaul (PL 111-148, PL 111-152) creates the potential to free up physician and staff time from insurance business.

"As a nation, we're spending far too much on paperwork," Schoen said. "We need to stop draining resources and redirect it for care."

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