Electronic Health Records in Ambulatory Care

DesRoches, Catherine M., Eric G. Campbell, Sowmya R. Rao, Karen Donelan, Timothy G. Ferris, Ashish Jha, et al. “Electronic Health Records in Ambulatory Care — A National Survey of Physicians.” N Engl J Med (June 18, 2008). Electronic Health Records in Ambulatory Care — A National Survey of Physicians.

This is an informative study of electronic health record penetration by the group at Massachusetts General Hospital, funded by the Office of the National Coordinator.

The news? Not very good. Only 4 % of physicians have “fully functional electronic record systems.” The numbers are even more concerning if you look at small practices, where the overwhelming majority of Americans receive care: 2 % in practices with 1-3 physicians. In other words, most American physicians use paper based medical records.

There are a few (among several) very good things that this research group has done:

  1. They have defined what is meant by “electronic health record” so we can track this over time
  2. They have found that there was NOT a difference in rates of adoption among providers serving minority patients, uninsured patients, or patients on Medicaid

With that in mind, here’s the hope that this brings:

  1. If we’re able to define what physician access to an electronic medical record is, let’s now define what patient access to that same electronic medical record is.
  2. Let’s begin to use that metric as a complement to, or instead of the physician access metric. In other words, the EHR is not really implemented unless the patients can access the data in it to manage their health and participate in their care.
  3. Let’s be excited about the fact that with adoption on par among providers serving the uninsured, minority, and patients on Medicaid, that patient access to the data can become as standard for these patients, as they may become for commercially insured patients.

On the topic of the “patient access” metric - I don’t think we currently have a good definition. One organization might say, “We have x-thousand patients accessing their clinical information through a portal.” Another might say, “We have x-percent penetration of our patient base accessing a portal with their clinical information.” Yet another might say, “X-percent of chronically ill patients are accessing a PHR that contains their claim data.”

Not to bring up the “c”-word (crowdsourcing), but maybe we should get together to figure out what patients consider “access to data that allows them to fully participate in their care.”

In the meantime, thanks to the team at Mass General and ONC for tracking the physician side of things - great work as always.

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