Health information technology plays a critical role in supporting high-quality, patient-centered, cost-effective care. New delivery system and payment models that will help our health care system achieve the triple aim— better health, better experience of care for patients and families, and reduced costs–are now rapidly emerging with leadership by the federal government, the private sector and states.
These new coordinated, accountable, patient-centered models of care require information technology that can facilitate the effective, efficient, and safe exchange of health information across the multiple clinicians and other provider organizations that deliver and support care for any individual patient. This exchange of information is especially important during transitions of care, when responsibility for a patient’s care is “handed off” from one clinician to another.
Most clinicians coordinate with hundreds of other clinicians in any given year. A typical primary physician coordinates with an average of 229 other physicians located in 117 different practices just for Medicare patients.
The Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 brought an unprecedented investment of $30 billion in health IT to improve the quality, safety, and efficiency of care. A majority of this investment is in the form of incentive payments to hospitals and clinicians through the Centers for Medicare and Medicaid Services’ (CMS) Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs—informally known as “Meaningful Use.”
The just-released final rules associated with Stage 2 of the Meaningful Use Program—which will go into effect in October 2013 for hospitals and January 2014 for eligible professionals—align considerably with the results of the survey. A detailed comparison of survey results to Stage 2 of Meaningful Use is contained in the report Accelerating Electronic Information Sharing to Improve Quality and Reduce Costs in Health Care.
This report presents the results of a survey of clinicians about their needs and preferences regarding electronic health information: what type of information they want in various care transitions, how they would like to receive it, and how quickly.
Their answers constitute invaluable data that will help both the public and private sectors plan, develop, and implement health information sharing capabilities that effectively meet the needs of clinicians and the patients they serve.
The survey was designed with two main goals in mind:
(1) To gain an understanding of clinician needs and preferences regarding electronic health information sharing necessary to support transitions in care.
(2) To ensure that clinician preferences inform the public and private sectors as they develop the policies, systems, and infrastructure needed to support electronic health information exchange across settings.
The survey asks clinicians to think about their health information needs and preferences in three scenarios: (1) when a patient in their care is discharged from the hospital, (2) when they are caring for a patient referred to them by another physician, and (3) when they refer a patient of theirs to another physician. Respondents are asked to rate the importance of receiving specific types of information, as well as how they would like to receive it and when.
(1) A majority of clinicians believe that electronic exchange of health information will have a positive impact on health care
A clear majority of clinicians surveyed believe that the electronic exchange of health information across care settings will have a positive impact on improving the quality of patient care, the ability to coordinate care, and the ability to not only meet the demands of new care models such as the patient-centered medical home and accountable care, but also participate in third-party reporting and incentive programs.
(2) About 70 percent of clinicians surveyed believe that the lack of interoperability and an exchange infrastructure, and the cost associated with both, are major barriers to electronic information sharing
More than 70 percent of clinicians surveyed identify lack of interoperability, lack of an information exchange infrastructure, and the cost of setting up and maintaining interfaces and exchanges as a major barrier, preventing clinicians from exchanging information with others.
(3) Access to medication lists and relevant laboratory and imaging test results are commonly recognized as high priorities for transitions of care
More than 80 percent of clinicians surveyed believe that medication lists, relevant laboratory test results, and relevant imaging test results are very important or essential types of patient health information to receive during transitions of care.
Not surprisingly, an overwhelming majority of clinicians surveyed also believe that the following are very important or essential:
- A discharge summary (defined as a summary of care provided and changes to the treatment plan) upon a patient’s discharge from the hospital;
- A reason for referral when a patient is referred to a consulting clinician
- A summary of care provided by and treatment plan changes recommended by a consulting clinician for review by the referring clinician
(4) More than half of respondents prefer that information they view as “essential” get “pushed” to them, with the ability to access the rest of the information through a query
When asked how they would like to receive or access information from other care settings to support clinical decision-making, more than half of clinicians surveyed indicate they would like only the information they characterize as “essential” to be “pushed” to them (e.g. somewhat like secure email), with the ability to access the rest of the information through a query (e.g. look-up function).
(5) Timeliness of information is important. A clear majority of clinicians consider “within 24 hours” to be a reasonable time frame for the exchange of information when a patient requires follow-up care or is being treated for an urgent problem
More than 80 percent of clinicians surveyed consider “immediately” or “within 24 hours” to be reasonable timeframes for the exchange of information when a patient requires follow-up care or is being treated for an urgent problem. More than 70 percent feel that “within 24 hours” or “within three business days” is a reasonable timeframe if the problem is non-urgent and/or no follow-up care is necessary.
(6) When updating the electronic health record with information received from an external source, clinicians prefer to be able to selectively pick and choose the information they want integrated
When asked how they want to update their EHRs (if they currently use them) with information received from an external source, fifty seven percent of clinicians surveyed said they prefer to selectively “pick and choose” the external information they want to integrate into their own EHR, rather than import all the information (16 percent).
About the Survey
The survey was developed and its results analyzed by Doctors Helping Doctors Transform Health Care and the American College of Physicians, the largest medical-specialty organization and second-largest physician group in the United States.
The survey was fielded by:
- AmericanEHR Partners, a program founded and managed by the American College of Physicians and Cientis Technologies and with the support of 17 additional medical societies
- American Academy of Pediatrics
- American College of Surgeons
- Association of Medical Directors of Information Systems (AMDIS)
Survey results are summarized in the report Clinician Perspectives on Electronic Health Information Sharing for Transitions of Care, published in collaboration with the Bipartisan Policy Center. Survey results also informed findings and recommendations of the Bipartisan Policy Center report Accelerating Electronic Information Sharing to Improve Quality and Reduce Costs in Health Care.
About the Survey Respondents
Seventy four percent of respondents to the survey worked in settings that have ten or fewer physicians. About half of the survey respondents work within a private ambulatory care office. Seventy five percent of respondents use an EHR in their primary work setting. A detailed analysis of survey respondents is provided on page 8 of the report.
Survey results do not necessarily represent the views or opinions of Doctors Helping Doctors Transform Health Care or its Advisory Board, the American College of Physicians, AmericanEHR Partners, American Academy of Pediatrics, American College of Surgeons, Association of Medical Directors of Information Systems (AMDIS), or the Bipartisan Policy Center.
Click here for a copy of the final report.
 Pham H.H., O’Malley A.S., Bach P.B., et al. (2009). Primary Care Physicians’ Links To Other Physicans Through Medicare Patients: The Scope Of Care Coordination. Annals of Internal Medicine. 150(4):236-242.