Are Electronic Medical Records Helpful for Care Coordination? Experiences of Physician Practices

Center for Studying Health System Change, 600 Maryland Ave, SW, Suite 550, Washington, DC 20024-2512, USA.
Journal of General Internal Medicine (Impact Factor: 3.42). 03/2010; 25(3):177-85. DOI: 10.1007/s11606-009-1195-2
Source: PubMed


Policies promoting widespread adoption of electronic medical records (EMRs) are premised on the hope that they can improve the coordination of care. Yet little is known about whether and how physician practices use current EMRs to facilitate coordination.
We examine whether and how practices use commercial EMRs to support coordination tasks and identify work-around practices have created to address new coordination challenges. DESIGN, SETTING: Semi-structured telephone interviews in 12 randomly selected communities.
Sixty respondents, including 52 physicians or staff from 26 practices with commercial ambulatory care EMRs in place for at least 2 years, chief medical officers at four EMR vendors, and four national thought leaders.
Six major themes emerged: (1) EMRs facilitate within-office care coordination, chiefly by providing access to data during patient encounters and through electronic messaging; (2) EMRs are less able to support coordination between clinicians and settings, in part due to their design and a lack of standardization of key data elements required for information exchange; (3) managing information overflow from EMRs is a challenge for clinicians; (4) clinicians believe current EMRs cannot adequately capture the medical decision-making process and future care plans to support coordination; (5) realizing EMRs' potential for facilitating coordination requires evolution of practice operational processes; (6) current fee-for-service reimbursement encourages EMR use for documentation of billable events (office visits, procedures) and not of care coordination (which is not a billable activity).
There is a gap between policy-makers' expectation of, and clinical practitioners' experience with, current electronic medical records' ability to support coordination of care. Policymakers could expand current health information technology policies to support assessment of how well the technology facilitates tasks necessary for coordination. By reforming payment policy to include care coordination, policymakers could encourage the evolution of EMR technology to include capabilities that support coordination, for example, allowing for inter-practice data exchange and multi-provider clinical decision support.

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Available from: Genna R Cohen, Mar 26, 2015
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    • "Electronic medical records (EMRs) can facilitate care coordination by providing immediate and remote access to the entire patient record (Goldberg, Kuzel, Feng, DeShazo, & Love, 2012). Some health care professionals report EMRs do enhance overall patient care (Goldberg et al., 2012) although they are considered less useful for betweensite care coordination because of poor communication and nonstandardized practices (Hysong et al., 2011; O'Malley, Grossman, Cohen, Kemper, & Pham, 2010). "
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    ABSTRACT: Purpose of the study: To examine the documentation of sensory impairment in the electronic medical records (EMRs) of Veterans with both hearing and vision losses (dual sensory impairment [DSI]). Design and methods: A retrospective chart review of the EMRs of 20 patients with DSI was conducted. Providers' documentation of the presence of sensory impairment, the use of assistive technology during clinical appointments, and the content of notes mentioning communication issues were extracted from each chart note in the EMR for the prior 6 years. Results: Primary care providers documented DSI in 50% of EMRs, vision loss alone in 40%, and hearing loss alone in 10% of EMRs. Audiologists documented vision loss in 50% of cases, whereas ophthalmologists/optometrists documented hearing loss in 15% of cases. Examination of two selected cases illustrates that care can be compromised when providers do not take note of sensory impairments during planning and provision of clinical care. Implications: Sensory impairment is poorly documented by most providers in EMRs. This is alarming because vision and hearing affect patient-physician communication and the use of medical interventions. The results of this study raise awareness about the need to document the presence of sensory impairments and use the information when planning treatment for individuals with DSI.
    The Gerontologist 05/2014; DOI:10.1093/geront/gnu032 · 3.21 Impact Factor
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    • "In a qualitative study of information management system impact on care coordination in the U.S., O’Malley et al. suggested that EMRs design was largely driven by documentation and billing rather than the needs of doctors and patients during the consultation [21]. Patient case management and collaborative decision-making remained difficult for health professionals, even when using the same EMR system. "
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    ABSTRACT: Background Primary care doctors in NHSScotland have been using electronic medical records within their practices routinely for many years. The Scottish Health Executive eHealth strategy (2008-2011) has recently brought radical changes to the primary care computing landscape in Scotland: an information system (GPASS) which was provided free-of-charge by NHSScotland to a majority of GP practices has now been replaced by systems provided by two approved commercial providers. The transition to new electronic medical records had to be completed nationally across all health-boards by March 2012. Methods We carried out 25 in-depth semi-structured interviews with primary care doctors to elucidate GPs’ perspectives on their practice information systems and collect more general information on management processes in the patient surgical pathway in NHSScotland. We undertook a thematic analysis of interviewees’ responses, using Normalisation Process Theory as the underpinning conceptual framework. Results The majority of GPs’ interviewed considered that electronic medical records are an integral and essential element of their work during the consultation, playing a key role in facilitating integrated and continuity of care for patients and making clinical information more accessible. However, GPs expressed a number of reservations about various system functionalities – for example: in relation to usability, system navigation and information visualisation. Conclusion Our study highlights that while electronic information systems are perceived as having important benefits, there remains substantial scope to improve GPs’ interaction and overall satisfaction with these systems. Iterative user-centred improvements combined with additional training in the use of technology would promote an increased understanding, familiarity and command of the range of functionalities of electronic medical records among primary care doctors.
    BMC Medical Informatics and Decision Making 05/2013; 13(1):58. DOI:10.1186/1472-6947-13-58 · 1.83 Impact Factor
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    • "Even though physicians have a positive perspective about EHR systems, their ‘full function’ adoption is still low: 3.6% in 2006, 3.8% in 2007 (4), 4% in 2008 (5), and 6.9% in 2009 (6). Literature indicates that technical barriers and inappropriate design elements explain the slow adoption, (5, 7) and yet these issues are challenging to address. EHR studies between 1995 and 2005 are generally categorized into four topics: the presence of an EHR, EHR adoption, EHR functionalities, and EHR disparities (8). "
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    ABSTRACT: Background: Electronic health records (EHRs) are structured, distributed documentation systems that differ from paper charts. These systems require skills not traditionally used to navigate a paper chart and to produce a written clinic note. Despite these differences, little attention has been given to physicians' electronic health record (EHR)-writing and -reading competence. Purposes: This study aims to investigate physicians' self-assessed competence to document and to read EHR notes; writing and reading preferences in an EHR; and demographic characteristics associated with their perceived EHR ability and preference. Methods: Fourteen 5-point Likert scale items, based on EHR system characteristics and a literature review, were developed to measure EHR-writing and -reading competence and preference. Physicians in the midwest region of the United States were invited via e-mail to complete the survey online from February to April 2011. Factor analysis and reliability testing were conducted to provide validity and reliability of the instrument. Correlation and regression analysis were conducted to pursue answers to the research questions. Results: Ninety-one physicians (12.5%), from general and specialty fields, working in inpatient and outpatient settings, participated in the survey. Despite over 3 years of EHR experience, respondents perceived themselves to be incompetent in EHR writing and reading (Mean = 2.74, SD = 0.76). They preferred to read succinct, narrative notes in EHR systems. However, physicians with higher perceived EHR-writing and -reading competence had less preference toward reading succinct (r= - 0.33, p<0.001) and narrative (r= - 0.36, p<0.001) EHR notes than physicians with lower perceived EHR competence. Physicians' perceived EHR-writing and -reading competence was strongly related to their EHR navigation skills (r=0.55, p<0.0001). Conclusions: Writing and reading EHR documentation is different for physicians. Maximizing navigation skills can optimize non-linear EHR writing and reading. Pedagogical questions remain related to how physicians and medical students are able to retrieve correct information effectively and to understand thought patterns in collectively lengthier and sometimes fragmented EHR chart notes.
    Medical Education Online 02/2013; 18(1):1-7. DOI:10.3402/meo.v18i0.18634 · 1.27 Impact Factor
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