EHR Adoption: U.S. Remains The Slow Poke

Two-thirds (69%) of U.S. primary care physicians reported using electronic health records (EHRs) in 2012, compared to 46% in 2009, according to a recent survey of doctors in 10 countries by the Commonwealth Fund, which published its report in the policy journal Health Affairs. That's a 50% jump in adoption -- but the U.S. still lags Australia, the Netherlands, New Zealand, Norway and the U.K., all of which have EHR adoption rates above 90%.

Moreover, just 27% of American doctors said they had EHRs with "multifunctional" capabilities. That's a far lower percentage than in other countries such as the U.K. (68%), Australia (60%), and New Zealand (59%), but higher than in Canada (10%), France (6%), Germany (7%), Norway (2%) and Switzerland (7%). The Netherlands was roughly comparable to the U.S. at 33%.

To measure EHR capabilities, the researchers asked physicians about electronic functions in four categories: The generation of patient information, such as lists of patients' medications; the generation of patient registry and panel information, such as a list of patients due for preventive care; order entry management, such as electronic prescribing; and decision support, such as alerts about potential adverse drug interactions. To be counted as a user of a multifunctional EHR, a practice had to report that its system had at least two functions in each of these four domains.

The adoption of multifunctional EHRs by U.S. primary care physicians was roughly similar to that of all doctors in other surveys. For example, the Centers for Disease Control and Prevention (CDC) reported in its latest survey that 57% of office-based physicians said they had an EHR, but only 34% said they had a system that met the CDC's criteria for a "basic EHR."

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Nevertheless, the U.S. is quickly closing the gap with other advanced countries and might even "leapfrog above the other countries," said Cathy Schoen, senior VP of policy, research, and evaluation at the Commonwealth Fund, in an interview with InformationWeek Healthcare.

"What I think is notable is how few countries have broad functionality across all the four areas we looked at," she said. "The countries that brought in electronic health records very early have been layering on functions. So we have the potential, because of Meaningful Use and the EHR standards, of moving faster as we move forward. Because we've got the advantage of looking at what the other countries already have, and how can we do it better. So this lag won't exist for that long."

Some nations have moved ahead faster on multifunctional EHRs because of how their healthcare systems or physicians are organized, Schoen noted. For example, New Zealand asked physicians what they were looking for and solicited bids and negotiated rates with EHR vendors around the world. When the Dutch GP association decided it was time for the country's primary care doctors -- who are mostly in small practices -- to get EHRs, they also negotiated with the vendors. And the National Health Service in the U.K. not only told vendors what it wanted but also told British primary care doctors what the government would provide to them.

Although New Zealand, the Netherlands and Switzerland are further ahead in health information exchange, the ability of doctors to exchange clinical summaries and lab results electronically "is not yet the norm in any country," the report said. The percentage of doctors who said they had this capability ranged from 14% in Canada to 55% in New Zealand, with the U.S halfway in between at 31%.

Health information exchange is still a big challenge around the world, Schoen said, "because it's pretty hard to do." HIE requires a lot of standardization in software structures and terminologies, she noted. In addition, medical specialties have different priorities in the types of information they want to exchange.

Another commonality across the 10 countries, the report found, was the low level of communication between primary care doctors and specialists and hospitals. The researchers did not find a correlation between the percentage of multifunctional EHR capability in a particular nation and the level of communications among providers, Schoen said, although there was some correlation in that respect in integrated delivery systems such as Kaiser Permanente.

Overall, the U.S. ranked low on patient access to primary care. Financial barriers were higher and access to after-hours care was lower here than elsewhere, the report found. However, patient electronic access to U.S. primary care practices fell in the middle of the international pack. Thirty-four percent of U.S. doctors reported that patients could e-mail them about questions of concerns; 30% allowed patients to request appointments or referrals online; and 36% refilled prescriptions online.

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