Study finds gap between EMR vision, reality
A gap exists between policymakers' expectations that electronic medical records can improve coordination of patient care and clinicians' real-world experiences with EMRs, according to a study by the Center for Studying Health System Change.
The study, published online in The Journal of General Internal Medicine and supported by The Commonwealth Fund, indicates ambulatory care EMRs facilitate care coordination in a practice by making information available at the point of care, but are less helpful for exchanging information across physician practices and care settings.
According to the study, clinicians have identified many areas where the design of EMRs could be altered and office care processes modified to improve EMRs' support for tasks involved in coordinating patient care.
While current commercial EMR design is driven by clinical documentation needs, there is a heavy emphasis on documentation to support billing rather than patient and provider needs related to clinical management, the study found. Current fee-for-service reimbursement encourages EMR use for documentation of billable events – such as office visits and procedures – and not for care coordination, which is not a billable activity.
"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, a co-author of the study.
Other researchers included HSC Senior Researcher Joy Grossman, PhD, HSC Research Assistant Genna R. Cohen, former HSC Research Analyst Nicole M. Kemper and HSC Senior Researcher Hoangmai H. Pham, MD.
"This work emphasizes that improving care coordination will not happen with technology alone," said Commonwealth Fund Vice President Anne-Marie Audet, MD. "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."
According to the study:
- EMRs may have unintended consequences for care coordination, such as creating information overload that complicates providers' efforts to discern key clinical information.
- Given the confines of the current payment system, creating incentives to adopt EMRs as they currently exist may result in EMRs being designed primarily for billing purposes rather than for clinical relevance to patients and care coordination.
- Clinicians believe EMRs have limited ability to capture dynamic planning and the medical decision-making processes in a way that supports future coordination needs – EMRs focus on linear documentation, they say, while care coordination is dynamic and ongoing.
- Maximizing the potential of an EMR for coordination involves ongoing evolution of clinical care processes as well as clinician input on EMR design modifications and standards for data exchange to support those processes.
- Modifying reimbursement to encourage coordination of care by clinicians will likely drive them to demand better EMR functioning to support coordination.