While electronic health record (EHR) adoption continues to grow in the U.S., health information exchange (HIE) and patient engagement remain low in office settings, according to new research.
The study, which appears in the September issue of Health Affairs, found that physicians’ electronic health information exchange with other providers was limited, with only 14 percent sharing data with providers outside their organization.
Additionally, it found that 30 percent of physicians routinely used capabilities for secure messaging with patients, and 24 percent routinely provided patients with the ability to view online, download, or transmit their health record. These findings suggest that although EHR adoption continues to grow, policies to support health information exchange and patient engagement will require ongoing attention, according to the study’s authors.
Data was used from from the 2009 National Ambulatory Medical Care Survey (NAMCS) and the 2009–13 Electronic Health Records Survey, a mail survey that was designed as a supplement to the NAMCS.
Early evidence on the impact of the Health Information Technology for Economic and Clinical Health Act (HITECH) suggested that its investments had accelerated the rate of EHR adoption. From 2010 to 2012 adoption of basic EHR systems and specific meaningful-use capabilities grew rapidly among U.S. ambulatory care physicians. Physicians who previously had significantly lower rates of adoption, including those who were older or worked in rural areas or areas with high rates of poverty, had the highest relative gains.
However, research showed that 39 percent of office-based physicians reported having any electronic HIE with other ambulatory providers or hospitals in 2013. Rates of HIE inside the organization were higher than those outside. Physician and practice characteristics were associated with engaging in HIE; physicians in larger practices had 36–99 percent higher odds of any electronic HIE, compared to solo practitioners.
The authors say there are many reasons why physicians may not be sharing clinical data with other providers, especially with those outside their organization. “There are privacy concerns and technical barriers because of incompatible systems. Limited interoperability of EHR systems across vendor platforms can hinder HIE, even among providers in the same organization. Additionally, HIE often requires the redesign of clinical work flow, which is inherently disruptive and may be difficult to justify in the absence of a clear business case for HIE.”
Additionally, the routine use of two patient engagement capabilities lagged behind the use of other such capabilities. In 2013, four in 10 physicians had the capability to enable patients to view online, download, or transmit their health information electronically. However, only about half of these physicians routinely used this capability. Similarly, only about a third of the physicians with secure messaging capability reported that it was routinely used. Among the physicians who had adopted patient engagement functionalities, practice size, type, and ownership were associated with a greater likelihood of routinely using the capabilities.
“Patients’ uptake of patient portals has been relatively low. Lack of awareness regarding the availability of these capabilities has been identified as a barrier, along with poor usability,” the authors said. “Second, physicians may worry that patient portals might generate a large volume of clinical issues that require responses (time for which the physician cannot bill). And finally, some providers are concerned that accessing these data might make patients confused or worried.”
The study’s authors were not surprised by the findings. “Indeed, we suspect that these results likely reflect greater access to financial resources, more managerial resources (the ability to choose and implement IT systems), or different care delivery models that require and more clearly reward a stronger IT infrastructure.”
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