One-Third Of Doctors Exchange Clinical Summaries

Healthcare Robotics: Patently Incredible Inventions

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Thirty-one percent of physicians said in a 2011 survey that they were exchanging patient clinical summaries with other providers, according to a paper recently published in the American Journal of Managed Care.

Fifty-five percent of respondents had the computerized capability to send prescriptions electronically; 67% could view lab results electronically; 42% were able to incorporate lab results in their electronic health record (EHR) system; and 35% were able to send lab orders electronically.

Researchers at the Office of the National Coordinator for Health IT (ONC) did the analysis based on data from the 2011 National Ambulatory Medical Care Survey (NAMCS) Electronic Medical Record Supplement. The national survey sample consisted of 4,326 physician respondents.

The ONC performed the study to measure the information exchange capabilities of physicians who had EHRs, said lead study author Vaishali Patel in an interview. "Measuring capability is important, because the study provides a baseline for showing readiness for Meaningful Use stage 2 and ensuring that physicians have the capability to exchange data. That's an important starting point. There may be other barriers to exchanging data, but having the computerized capability is critical," she said.

The results showed conclusively that doctors with EHRs had much greater exchange capabilities than those who didn't. For example, Patel noted, "Very few physicians who don't have EHRs can exchange clinical summaries with patients or other providers or send lab orders electronically."

However, substantial numbers of physicians without EHRs could send prescriptions (23%) and view lab results (42%) electronically. The study said standalone e-prescribing products and Web portals, respectively, were being used by many of these doctors.

Among physicians who had an EHR, the study found:

• 78% could send prescriptions electronically; • 87% percent could view electronic lab results; • 73% could incorporate lab results into their EHR; • 54% could send an electronic order to a lab; • 61% percent could provide clinical summaries to patients; and • 49% had exchanged patient clinical summaries with another provider.

The overall percentages of physicians who could exchange data varied by state, specialty, practice arrangement, and EHR vendor. For example, the percentage of physicians who exchanged clinical summaries with other providers varied from 61% in Wisconsin to 15% in Alabama. Practices owned by HMOs were more likely to exchange all six types of clinical data than physician-owned practices, and hospital-employed providers were more likely than other respondents to receive lab results electronically and exchange clinical summaries with other providers. Bigger practices also tended to have better exchange capabilities in general but did not necessarily exchange more clinical summaries with other providers.

Primary-care physicians were more likely than specialists to have exchange capabilities. This was partly because a higher percentage of PCPs than specialists had EHRs in 2011, Patel said. Also, she noted, PCPs' patients are more likely to see other providers. "So they have a greater need to exchange information with other entities, whether that's pharmacies, labs, or other providers, as compared to specialists."

The NAMCES did not ask about the use of health information organizations (HIOs) to exchange data, but Patel believes that some doctors who said they used EHRs for exchange might have been connected to HIOs. Sixty-four percent of respondents who exchanged clinical summaries with other providers said they did so through an EHR and 28% did so through a hospital portal. In 2010, another study found, just 14% of hospitals and 3% of physician practices participated in HIOs. Two years later those numbers had grown to 30% of hospitals and 10% of practices.

The study also noted the large range of EHR capabilities in exchanging data. Between 24% and 77% of physicians said their EHRs allowed them to exchange clinical summaries with other providers, and from 22% to 90% said their EHR permitted them to share clinical summaries with patients.

Only 54% of respondents with EHRs said they could send lab orders electronically, but it was unclear whether this was because of their EHRs or because they lacked interfaces with labs.

Matthew Swain, another coauthor of the study, said the ONC is especially concerned about whether physicians can incorporate lab results into their EHRs using the LOINC nomenclature. The agency plans to do a national survey of clinical labs to find out where there are gaps in the ability of labs to send results in this format, he said.

The results of the 2013 NAMCES EMR Supplement -- which includes questions about how physicians are exchanging data and with whom -- will be in by early next year, Patel said.