Study: EMRs fall short for providers

WASHINGTON – Policymakers’ hopes that electronic medical records can substantially improve the quality and coordination of patient care don’t really fit with clinicians’ real-world experiences with commercial EMRs, according to a new study in The Journal of General Internal Medicine.
The study, by the Center for Studying Health System Change, found “a real disconnect” between the vision and the reality, said Dr. Ann S. O’Malley, a senior researcher at HSC.
Most commercial EMR products do make it easier for providers within the same practice to coordinate care by making information available at the bedside, the study found. But they don’t do much to connect providers across practices and in different care settings.
In addition, most commercial EMRs emphasize clinical documentation that is needed to support billing, rather than patient care needs, the study found. Since most providers are now paid based on a fee-for-service model, which doesn’t generally consider care coordination a billable activity, the focus is on billable events, such as visits and procedures.
“This work emphasizes that improving care coordination will not happen with technology alone,” said Dr. Anne-Marie Audet, vice president of the Commonwealth Fund. “What is needed is a redesign of care processes and work flow; clinicians will also need to adopt new ways of working and communicating within practices and across organizations.”
The study also found that EMRs may have “unintended consequences” for care coordination, such as creating “information overload” that makes it harder for clinicians to identify crucial information.
And clinicians said current EMRs are of limited use in planning and coordinating patients’ care in the long term, because they focus on moment-in-time documentation.
The study suggests that clinical care processes be further refined to promote coordination, and that doctors’ input be sought to ensure EMRs support that kind of work. If reimbursements are also changed to encourage coordination of care, the study says, clinicians will probably put pressure on EMR vendors to improve those functions in their software.
The journal article, titled “Are Electronic Medical Records Helpful for Care Coordination? Experiences of Physician Practices,” is based on 60 interviews with 52 doctors and other staff at 26 small and medium-sized physician practices with commercial ambulatory EMRs in place for at least two years; chief medical officers at four EMR vendors; and four national “thought leaders” active in health information technology implementation, the HSC said.
The Center for Studying Health System Change is a nonpartisan policy research organization based in Washington, D.C., and funded in part by the Robert Wood Johnson Foundation. It is affiliated with Mathematica Policy Research.