Use of electronic health records was reported by 46% of the U.S. primary-care doctors—up from 28% in 2006—but this still put them in 10th place ahead of only Canada, where EHRs were used by only 37% of the physicians surveyed.
The report reaffirmed other surveys that indicate advanced use of EHRs in the U.S. is concentrated in large integrated group practices or health systems. In the seven countries reporting use rates of 94% or higher, however, there was little difference in the rate of advanced use among practices of varying sizes. Advance use was described as using at least nine of 14 possible health IT functions. In the seven top EHR-using countries—the Netherlands (99%), New Zealand (97%), Norway (97%), United Kingdom (96%), Australia (95%), Italy (94%) and Sweden (94%)—the report stated that: "Their national policies and standards have supported spread of multifunctional capacity."
In New Zealand, 92% of the responding physicians reported using between nine and 14 health IT functions, this was followed by Australia at 91% and the United Kingdom at 89%. This level of advanced use of health IT functions was reported by only 26% of the U.S. respondents, and low use—zero to three functions—was reported by 51%. The report noted that, although EHR "use is nearly universal" in Norway (97%), advanced HIT use was reported by only 19% of respondents, with most (66%) reporting that they use between four and eight HIT functions.
These functions included electronic prescribing, alerts for possible medication errors, ordering lab tests and viewing results, and prompts for preventive and follow-up care. Sweden reported the highest use of communicating clinical information via e-mail, 35%; while Canada reported the lowest, 6%.
Davis appeared at a news conference with the lead authors of the report: Cathy Schoen, Commonwealth Fund senior vice president for research and evaluation; and Robin Osborn, vice president of the Commonwealth Fund's international program in health policy and practice. All three cited other studies that indicated that the countries with high use of EHR functions had better outcomes for patients with chronic conditions.
Schoen said these included lower rates of diabetic patients dying before age 50, and lower mortality rates for children with chronic lung problems. Osborn noted how emergency-room use by chronic condition patients was very low in the Netherlands, where EHR use was reported at 99% and use of nine to 14 functions were reported by 54% of respondents.
"Functionality is very much related to patient outcomes and quality of chronic care," Davis said.