A greater percentage of primary care doctors in the U.S. now use electronic medical records in their practices, according to an international survey by the Commonwealth Fund, but lag in other indicators of affordability and administrative time. The survey findings were reported online today in the journal Health Affairs.
The research team, led by Commonwealth Fund’s vice president Cathy Schoen, that included survey experts from Harris Interactive, interviewed by mail and telephone some 8,500 primary care physicians in Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Switzerland, the United Kingdom, and the United States. Interviews took place from March through July 2012, and covered issues such as patient access, health information technology, communication, overall views of the health system, and job satisfaction.
The results show the percentage of U.S. primary care doctors using electronic medical records increased from less than half (46%) in 2009 to seven in 10 (69%) in 2012, about the same rate as in France. While the proportion of U.S. and Canadian physicians using electronic record-keeping technology jumped in the past three years, their rate of electronic records use is still well below other industrialized nations, notably Netherlands, Norway, New Zealand, the U.K., and Austria, where nine in 10 or more use electronic medical records. (See chart below)
High rates of electronic medical record use do not appear to resolve long-standing communication issues between primary care physicians and other health care providers. In each country surveyed — even in countries where nearly all physicians have these systems — a minority of primary care doctors say they always receive timely information from specialists after referring patients to them. Only 11 percent of primary care physicians in the U.S. say they get such information when it is needed. Also, from one-third to more than half of the doctors in each country surveyed say they are not always notified when their patients leave the hospital.
The ability of primary care physicians to exchange information electronically with doctors outside their practice is still largely the exception than the rule in the countries surveyed. In New Zealand, the Netherlands, and Switzerland about half of the doctors report having that capability, compared to about three in 10 doctors (31%) in the U.S.
Most primary care physicians in the U.S. report affordability of health care for patients as an issue, a condition not found in the nine other countries that provide universal health coverage. Some six in 10 (59%) U.S. primary care doctors say their patients often have trouble paying for care. In other countries, the rate reporting patients with health care affordability problems ranges from 4 percent in Norway to 25 percent in Australia.
About half (52%) of U.S. doctors say insurance restrictions on their care decisions are a major time concern, a far higher rate than other countries. And less than two in 10 primary care physicians in the U.S. (15%) agree that their national health care system works well.
Schoen sums up the survey results, noting “The U.S. spends far more on medical care than the other countries we surveyed, yet our doctors are telling us their patients can’t afford care, they don’t always have the patient information they need, they spend too much time dealing with insurance companies, and we need major change.” Schoen adds, “The insurance expansions under the Affordable Care Act will make care more affordable, but we also need to simplify insurance to free up physicians to provide timely access to high-quality care for their patients.”
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