Electronic health-record systems are firmly entrenched within the academia of family medicine. However, the quality of the systems used at academic medical practices where family practice is taught still leaves much to be desired and may require some home-grown modifications to meet the needs of the specialty, according to the results of a survey by the Association of Departments of Family Medicine. The study was published in the current issue of the Annals of Family Medicine
, the journal of the American Academy of Family Physicians.
The Leawood, Kan.-based AAFP's Center for Health Information Technology and its Future of Family Medicine Project in a 2004 report called for family practitioners to embrace EHR systems as an essential tool to create patient-centered medical homes within their practices. So, it's not surprising that academic medical practices where new family physicians are trained would have embraced EHRs to a large degree.
Sixty-one percent of the Departments of Family Medicine member departments responded to the survey, according to the article, "Electronic Health Records in Academic Family Medicine Practices: A Tale of Progress and Opportunity." Of the respondents, 62% of the department clinical practices were owned by their universities and 25% were owned by their sponsoring hospital.
Of the respondents, 72% currently have an EHR implemented while another 18% plan to do so within the next 12 months. But 64% of respondents said their EHR systems have been in use only for five years or less and, for most practices, the devices are being used as basic tools to record and retrieve information but lack higher-level functionality such as automated clinical-decision support.
For example, 61% of practices reported their EHRs record clinical information through a combination of template-guided entry and free text, 87% had electronic prescribing and 89% provided drug safety information at the point of care. But just 38% of respondents indicated their systems could provide the clinician and patient information about the cost of a prescribed drug while only 49% were capable of printing out patient information about the drug being prescribed.
Meanwhile, more than half, 53%, had no point-of-care clinical decision-support functionality and less than a third, 31%, had built-in reminders for chronic disease care. Just 15% were equipped for electronic patient visits.
"This survey of academic departments suggests that EHRs are quickly becoming a reality in our teaching practices," the authors said. "While we have benefited from the startup capital and technologic expertise offered by our large, affiliated health science centers, we are also struggling with the challenges of slow implementation and lack of incorporation of important items such as decision support, registry use, quality indicator reporting and electronic communication that are hallmarks of the Future of Family Medicine report.
"We must also be strong advocates for, and demonstrate the effectiveness of, a well-designed ambulatory EHR in helping us provide higher quality care at a lower cost to the patient and the health system," the authors said. "This initially may require creating or purchasing our own 'add-ons,' such as disease registries or secure practice Web sites for e-visits. Ultimately, playing a central leadership role in systemwide EHR implementation or revisions will be likely to produce substantially better, and more sustainable, results. Much education remains to be done, and there is a compelling need for us to find ways to sell this vision to our health systems, lest we lose the opportunity to truly model patient-centered practice to our learners."
The relative dearth among academic medical practices of the more sophisticated EHR systems with high-end functionality is mirrored by family physicians in nonacademic practices, according to physician informaticist Steven Waldren, director of the AAFP's Center for Health Information Technology.
Based on a separate survey of AAFP rank-and file members, the adoption of EHR technology in general was relatively high, Waldren said, with 37% of survey respondents reporting they had "a fully implemented EMR" and another 13% saying they were in the process of implementing one. Another 25% "were still thinking about it," he said, while 25% said they had no intention to purchase an EHR at this time.
Regarding functionality, between 70% and 90% of those who had EHRs reported their systems were being used to document a patient encounter or to provide clinician access to patient information. "The highest was remote access, and that was over 90%," Waldren said.
But when it came to more sophisticated EHR functions, such as point-of-care decision support, creating a disease registry or true e-prescribing, "it quickly dropped down to the 20% to 40% and 50% range," Waldren said.
The concept of patient-centered medical homes is "getting a lot of play at the federal level and in Congress," Waldren said. But until physician adoption rates of EHRs rise, it remains an issue of "putting the cart before the horse," he said. "The difficulty becomes we're asking our members to do something new in addition to what they're already doing. That's hard until they see there is really a benefit financially for them to do that. What we're trying to do is increase the efficiency of our practices and to give them a little breathing room so they can do these things they need to do to drive payment reform. So, we hope to get some large-scale pilots done to validate that it does increase quality."
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