Despite the promise of health IT to improve care coordination, there has been sluggish progress in the use of health IT to connect doctors and patients, according to a new survey report from Nielsen Strategic Health Perspectives.
The survey, sponsored by the Council of Accountable Physician Practices (CAPP), polled 30,000 consumers and 626 physicians to monitor the progress of healthcare delivery reform and the movement toward accountability. The survey measured respondents’ experiences with the five patient benefits associated with effective accountable care: care team coordination, prevention, 24/7 access, evidence-based medicine, and patient and physician access to and use of robust information technology.
Overall, according to the survey report’s Patient Experience Report Card regarding coordinated, accountable care, some encouraging findings were that about half of patients have experienced coordinated care and about one third have physicians follow up, and most physicians report using evidence-based guidelines. However, with regard to 24/7 access to care, only about one-third of patients have 24/7 access to care outside of the emergency department. And, the use of health IT needs work, according to the survey, as the use is growing but still rare, and older patients are not interested in having access to it. With regard to preventive primary care, most patients do not get the message, if one is delivered, especially around weight management, the survey authors stated,
“Our survey found that while it is encouraging that the use of care teams and care coordination seem to be increasing, access and the effective use of technology still need improvement, and tactics that help to prevent illness are still woefully ineffective,” CAPP executive director Laura Fegraus said in a statement.
The survey found that only half of patients report that their physicians better know their history, primarily due to the ability to share information through electronic medical records, which indicates that half the time, patient information is not being shared across providers.
And, patients with multiple chronic conditions, who are the patients who could most benefit from better care coordination, report receiving only slightly more follow-ups and care management compared to healthier patients. Patients with chronic illnesses do not perceive more coordination of care, the survey authors stated. For instance, the survey indicates that 39 percent of chronically ill patients report that their primary care doctor’s office has a nurse or care manager to help the patient stay on track or comply with treatment instructions, compared with 37 percent of total patients.
The survey examined whether physicians are utilizing technology to improve care, and the survey findings indicate that access to electronic engagement is increasing but remains low. And, of those with access, the percentage of consumers actually using their access to digital tools also remains low. Of those surveyed, only 14 percent reported having access to and actually using a digital tool that enables online submission of questions to be answered by a medical professional. About 25 percent reported having access, whether they use the access or not, and that number grew from only 11 percent in 2015.
And, only 10 percent reporting having access to and actually using email reminders about taking medications or reminders about other health measurements. Nineteen percent reported having access to this type of electronic engagement, which increased from only 6 percent in 2015. More are reporting having access to and using text appointment reminders, 21 percent in 2016, and the percentage that now have access to that type of electronic engagement grew significantly, up to 32 percent from only 9 percent in 2015.
Roughly 44 percent report access to online information, such as appointment scheduling, obtaining lab test results, or viewing information via portals. According to the survey findings, about half to one-third of patients with online access don’t use it. For instance, 48 percent of patients now have access to an online portal to log on and see lab tests, imaging results or other information, up from 28 percent in 2015, but only 35 percent report having access and actually using it.
Patient perceptions about shared electronic medical record (EMR) information hasn’t changed from 2015. Forty-nine percent of patients say their doctors are now able to share information about their health and know their history before going to the appointment, and in 2015, 46 percent of patients reported that.
And, the survey found that patient-physician engagement around mobile apps remains low, as only 4 to 5 percent of patients reported that their primary care physicians recommended using a mobile app to track physical activity levels or monitor biometrics or recommended using a wearable health monitor.
With regard to the use of health IT, older Americans are less likely to want to use digital technology for healthcare, which presents a challenge in fully leveraging this technology to improve care delivery to this population. Only 20 percent of patients age 65 and older have access to and use online appointment scheduling, compared to 26 percent of patients age 18 to 64. And, in addition, 29 percent of seniors have access to online appointment scheduling, but don’t use it. Also, only 10 percent of seniors don’t have access to this digital tool, but want access, and a quarter of senior patients don’t want access to online appointment scheduling.
Text reminders are least appealing to older patients, with 57 percent reporting they don’t have access and don’t want access to text reminders for taking medications.
In general, the survey finds, physicians are moving towards high-tech patient engagement, but slowly. Of the physicians surveyed, 31 percent in 2015 report having email correspondence with patients about health, up from 28 percent in 2014. Half (50 percent) report offering an online portal for patients to see lab tests and other information, up from 41 percent in 2014.
In conclusion, CAPP recommended a number of policy levers to help close the gap and expedite performance in accountable care, including payment reform to support “system-ness” and better outcomes; more robust health information technologies to improve sharing of information among providers and easier access by consumers; and standardized quality measures in language consumers can understand.