A gap appears to exist between policymakers' expectations of commercial electronic medical records (EMRs) in supporting care coordination and the way they are actually used by providers and clinicians in the healthcare environment, according to a new analysis by researchers at the Center for Studying Health System Change (HSC) in Washington, DC.
Current ambulatory care EMRs are designed to promote care coordination within a practice by making information available at the point of care. However, they actually appear less helpful for exchanging information across physician practices and care settings, according to the study, which was supported by the Commonwealth Fund. The study is published online in The Journal of General Internal Medicine.
While current commercial EMR design is driven by clinical documentation needs, the emphasis on documentation focuses on supporting billing rather than patient and provider needs related to clinical management, the researchers found. Overall, current fee for service reimbursement encourages EMR use to document billable events—such as office visits or procedures—and not care coordination, which is not a billable activity, they added.
Just promoting incentives to adopt EMRs as they currently exist—given the confines of the current payment system—could result in EMRs being designed primarily for billing purposes rather than for clinical relevance to patients and care coordinators, the researchers added.
"There's a real disconnect between policymakers' expectations that current commercial electronic medical records can improve care coordination and physicians' experiences with EMRs," said HSC Senior Researcher Ann S. O'Malley, MD, MPH, a coauthor of the study.
For the study, 60 respondents were interviewed, including: 52 physicians or staff from 26 practices with commercial ambulatory care EMRs in place for at least two years; chief medical officers at four EMR vendors; and four national thought leaders.
Other findings that emerged are:
- 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 needed for information exchange.
- EMRs' potential for facilitating coordination requires evolution of practice operational processes.
- Management of information overflow from EMRs is a challenge for clinicians who believe current EMRs cannot adequately capture the medical decision making process or future care plans to support coordination.
Policymakers should place more emphasis on current health information technology policies to support how well tasks are coordinated, the researchers said. Also, payment reform policies should find ways to specifically "include capabilities that support coordination"—allowing for "interpractice data exchange and multiprovider clinical decision support."