Electronic Record Systems Often Fail to Meet Lofty Goals

Psychiatrists using available electronic medical records may not see much improvement in patient care coordination, according to a recent report.

Improved patient care coordination has been highlighted as one of the likely benefits of widespread physician adoption of electronic medical records (EMR). An interview-based survey of physician experiences with ambulatory care EMRs found, however, that they do little to improve care coordination between clinicians who are not in the same practice or health system. Psychiatrists who have moved to EMRs often adapt ambulatory care systems, which are closest to a mental health–specific program.

The research, based on interviews with 52 physicians and staff from 26 practices across the country that have used a commercial ambulatory EMR system for at least two years, found current EMRs offer electronic message functions to facilitate intraoffice communication. However, most clinicians still rely on faxes for inter-office communications with other clinicians treating the same patient.

The research was led by Ann O'Malley, M.D., M.P.H., a senior researcher at the Center for Studying Health Change. The results appeared in the December 22, 2009, Journal of General Internal Medicine.

“If [physicians] have an EMR system, they may take the fax and scan it into their EMR program,” O'Malley told Psychiatric News.

Patient care coordination—vitally important to many psychiatrists whose patients often have co-occurring nonpsychiatric illnesses—should improve with the finalization of emerging federal performance and interoperability standards. Those standards stem from a $19 billion program to reimburse physicians for the cost of installing an EMR system in their practices (see EHR Reimbursement Proposal Troubles Psychiatrists).

Those federal standards aim to help facilitate better physician sharing of basic patient information, such as medication lists. Federal regulators will take longer to develop standards on sharing more complex but critical information, such as summaries of patient problems that are very helpful in care coordination, O'Malley said.

Psychiatrists should not interpret the lack of finalized federal standards or O'Malley's findings as reasons to drop plans to buy a commercial EMR system, she said. However, they should proceed cautiously.

It is important that physicians ensure that the manufacturer of the commercial EMR system that the clinician intends to buy will commit in writing to provide all future upgrades needed to meet emerging federal guidelines.

O'Malley also noted that despite problems with system interoperability, the clinicians interviewed for her research reported that their practice was improved after adopting an EMR system.

Additionally, she noted that even after fully interoperable EMR systems are in widespread use, clinicians will still need to call other clinicians treating the same patient when there is a need for urgent “real-time communications.”

Another barrier to the adoption of EMRs is the payment systems for most public and private insurance programs, which currently do not provide physician reimbursement for the time that such care coordination requires.

“Are Electronic Medical Records Helpful for Care Coordination? Experiences of Physician Practices” is posted at <www.commonwealthfund.org/Content/Publications/In-the-Literature/2009/Dec/Are-Electronic-Medical-Records-Helpful-for-Care-Coordination-Experiences-of-Physician-Practices.aspx>.