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

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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.
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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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    Full-text · Article · May 2013 · BMC Medical Informatics and Decision Making
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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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