A study conducted by the Commonwealth Fund, published in this month's issue of Health Affairs, found that physicians in the United States significantly lag behind their colleagues in Western Europe, Australia and New Zealand in several categories, including rates of adoptions of electronic medical records. This study of more than 10,000 primary care physicians in 11 countries found that only 46% of U.S. doctors use electronic medical records, compared with almost universal EMR use among doctors in Australia (95%), Italy (94%), the Netherlands (99%), New Zealand (97%), Norway (97%), Sweden (94%), and the United Kingdom (96%). Among other HIT-related findings, the study concluded that:
<...> among the seven countries with near-universal EMRs, the majority of physicians reported electronic access to lab results, yet fewer than half of Dutch, Norwegian, and U.K. doctors can order tests electronically. Across countries, most doctors with EMRs reported electronic clinical notes, routine electronic prescribing, and computerized alerts about potential problems with drug doses or interactions (except in Norway). Answers varied for other functions.
Decision support appears generally less well developed. Computerized reminders for treatment guidelines, tracking laboratory tests, and prompts to provide patients with test results were the least frequently reported, including in countries with multifunctional capacity. Notably, the seven countries with near-universal EMRs have succeeded in spreading multifunctional capacity to smaller as well as larger practices. Their national policies and standards have supported spread of multifunctional capacity. In contrast, U.S. multifunctional capacity remains concentrated in larger practices. Half of U.S. practices with high-function capacity were associated with integrated care systems such as Kaiser.
However, the study also found a high rate of increase of EMR use among U.S. doctors, rising from 28% to 46% from 2006 to 2009. At the same time, only 26% of U.S. physicians were reported to have "advance electronic information capacity" (i.e., reporting use of more 9 - out of 14 - clinical IT functions such as e-prescribing and ordering tests, Rx alerts, clinical notes, and others).
The situation seems even more dire in Canada, where only 37% of physicians use EMRs, and only 14% have "advance electronic information capacity."
On the access, cost and quality of care issues, the Commonwealth Fund study found that:
More than half (58%) of U.S. physicians—by far the most of any country surveyed—said their patients often have difficulty paying for medications and care. Half of U.S. doctors spend substantial time dealing with the restrictions insurance companies place on patients’ care.
Only 29 percent of U.S. physicians said their practice had arrangements for getting patients after-hours care—so they could avoid visiting a hospital emergency room. Nearly all Dutch, New Zealand, and U.K. doctors said their practices had arrangements for after-hours care.
Twenty-eight percent of U.S. physicians reported their patients often face long waits to see a specialist, one of the lowest rates in the survey. Three-quarters of Canadian and Italian physicians reported long waits.
While all the countries surveyed use financial incentives to improve the quality of care, primary care physicians in the U.S. are among the least likely to be offered such rewards; only one-third reported receiving financial incentives. Rates were also low in Sweden (10%) and Norway (35%), compared with large majorities of doctors in the U.K. (89%), the Netherlands (81%), New Zealand (80%), Italy (70%), and Australia (65%).
Patients with chronic illness require substantial time with physicians, education about their illness, and coaching about treatment, diet, and medication regimens. Care teams composed of clinicians and nurses have been shown to be effective in providing care to people with chronic conditions and in improving outcomes. The use of such teams is widespread in Sweden (98%), the U.K. (98%), the Netherlands (91%), Australia (88%), New Zealand (88%), Germany (73%), and Norway (73%). It is less prevalent in the U.S. (59%) and Canada (52%), with France (11%) standing out on the low end.
You can find the Commonwealth Fund study here, and please be sure to take a look at the accompanying graphs here.
"A Survey Of Primary Care Physicians In Eleven Countries, 2009: Perspectives On Care, Costs, And Experiences," Health Affairs (November 5, 2009).
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