Journal of General Internal Medicine

, Volume 25, Issue 3, pp 177–185

Are Electronic Medical Records Helpful for Care Coordination? Experiences of Physician Practices

  • Ann S. O’Malley
  • Joy M. Grossman
  • Genna R. Cohen
  • Nicole M. Kemper
  • Hoangmai H. Pham
Original Article
  • 2.3k Downloads

Abstract

BACKGROUND

Policies promoting widespread adoption of electronic medical records (EMRs) are premised on the hope that they can improve the coordination of care. Yet little is known about whether and how physician practices use current EMRs to facilitate coordination.

OBJECTIVES

We examine whether and how practices use commercial EMRs to support coordination tasks and identify work-arounds practices have created to address new coordination challenges.

DESIGN, SETTING

Semi-structured telephone interviews in 12 randomly selected communities.

PARTICIPANTS

Sixty respondents, including 52 physicians or staff from 26 practices with commercial ambulatory care EMRs in place for at least 2 years, chief medical officers at four EMR vendors, and four national thought leaders.

RESULTS

Six major themes emerged: (1) EMRs facilitate within-office care coordination, chiefly by providing access to data during patient encounters and through electronic messaging; (2) EMRs are less able to support coordination between clinicians and settings, in part due to their design and a lack of standardization of key data elements required for information exchange; (3) managing information overflow from EMRs is a challenge for clinicians; (4) clinicians believe current EMRs cannot adequately capture the medical decision-making process and future care plans to support coordination; (5) realizing EMRs’ potential for facilitating coordination requires evolution of practice operational processes; (6) current fee-for-service reimbursement encourages EMR use for documentation of billable events (office visits, procedures) and not of care coordination (which is not a billable activity).

CONCLUSIONS

There is a gap between policy-makers’ expectation of, and clinical practitioners’ experience with, current electronic medical records’ ability to support coordination of care. Policymakers could expand current health information technology policies to support assessment of how well the technology facilitates tasks necessary for coordination. By reforming payment policy to include care coordination, policymakers could encourage the evolution of EMR technology to include capabilities that support coordination, for example, allowing for inter-practice data exchange and multi-provider clinical decision support.

KEY WORDS

electronic medical record coordination of care primary health care quality medical home health information technology data standards 

Supplementary material

11606_2009_1195_MOESM1_ESM.doc (154 kb)
ESM1 (DOC 153 kb)

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Copyright information

© Society of General Internal Medicine 2009

Authors and Affiliations

  • Ann S. O’Malley
    • 1
  • Joy M. Grossman
    • 1
  • Genna R. Cohen
    • 1
  • Nicole M. Kemper
    • 1
  • Hoangmai H. Pham
    • 1
  1. 1.Center for Studying Health System ChangeWashingtonUSA

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