Physician Capability to Electronically Exchange Clinical Information, 2011 | Page 3
Published Online: October 23, 2013
Vaishali Patel, PhD, MPH; Matthew J. Swain, MPH; Jennifer King, PhD; and Michael F. Furukawa, PhD
Larger practice size was significantly associated with the capability to conduct all facets of electronic lab exchange and was a particularly strong predictor of the capability to incorporate lab results into an EHR. Practice size was also significantly associated with the capability to e-prescribe (P <.001). However, practice size was not a significant predictor of capability to exchange clinical summaries.
Physicians practicing in multispecialty practices were more likely to have the capability to e-prescribe (P <.05), send lab orders electronically (P <.001), and exchange clinical summaries with other providers (P <.001) compared with singlespecialty practices. However, overall, practice type was not a strong predictor of exchange capability.
Physician Characteristics. Primary care physicians were more likely to have the capability to e-prescribe (P <.001) and engage in various forms of lab exchange (P <.001), as well as provide clinical summaries to patients (P <.05) compared with specialists. Age differences were not associated with most forms of exchange capability; physicians aged less than 50 years were only slightly more likely to possess the capability to provide clinical summaries to patients (P <.05) compared with older physicians.
Variation in Physician Exchange Capability by EHR Vendor
Among physicians using an EHR, capability to exchange different types of clinical information varied according to EHR vendor (Figure 3). Between 73% and 94% of physicians using an EHR reported that they possess the capability to eprescribe, depending upon their vendor. Most EHR vendors (between 80% and 99%) provide the capability to receive lab results electronically. Depending upon the EHR vendor, between 62% and 95% of physicians reported the capability to incorporate lab results into their EHR. Physicians’ capability to send lab orders electronically ranged from more than onethird (38%) to 87% depending upon the EHR vendor.
Large differences existed across EHR vendors with regard to capability to exchange clinical summaries. EHR vendor capability to provide clinical summaries to patients ranged from 22% to 90% of physicians. Between one-fourth (24%) and three-fourths (77%) of physicians reported the capability to exchange clinical summaries with other providers, depending upon their EHR vendor.
In 2011, a majority of office-based physicians possessed the capability to electronically exchange lab and medication data, and approximately one-third could exchange clinical summaries with patients or other providers. These estimates represent a baseline in measuring progress of national programs under way to promote greater exchange activity.
Variation in exchange capability may be driven by market factors and policy levers, as well as idiosyncratic work flow issues associated with each type of clinical data.17 Greater physician capability to view laboratory results and e-prescribe may be due in part to the role of large vendors (eg, Surescripts) and to hospital-physician portals.7 In addition to the implementation of meaningful use stage 1 requiring physicians to eprescribe using a certified EHR, other national policies, most notably the Medicare Improvements for Patients and Providers Act, have also likely spurred e-prescribing uptake.18,19 Lower capability to incorporate lab results into an EHR may be due to technical challenges in transforming unstructured laboratory results into a structured format that involves agreement on vocabularies and standards.20
Lower rates of physicians’ exchange of clinical summaries may reflect technical and operational barriers to care coordination.7 For example, some physicians reported that summaries are not integrated within their work flow, prompting them to fax information between providers with EHRs rather than transmit summaries electronically; some physicians also reported that standard clinical care summaries can contain extraneous information, making them difficult to use.4 Rates of exchange of clinical care summaries may also be lower because the survey assessed exchange activity as opposed to the capability to exchange. However, rates of clinical care summary exchange may increase with the implementation of stage 2 meaningful use, which requires physicians to exchange clinical summaries with other providers during transitions of care.
Although in theory EHRs are expected to facilitate exchange, few empirical studies have examined EHRs as a vehicle for exchanging data among providers. To date, stand-alone systems and proprietary web portals have facilitated accessto clinical data. Studies demonstrating the impact of HIE in an ambulatory care setting have largely been limited to portal users.21,22 Furthermore, EHRs have been criticized for their lack of interoperability, including their inability to facilitate exchange of data easily between providers.23 We found that a majority of physicians who have EHRs reported they have the capability to exchange different types of clinical information, and multivariate analyses demonstrated that having an EHR was the single strongest predictor of exchange capability for e-prescribing, laboratory test viewing and ordering, and exchanging clinical summaries. Although stand-alone systemsmay continue to play a significant role, our findings indicate that EHRs have the capability to exchange a wide variety of clinical information with patients, providers, and other entities, in addition to serving as a more comprehensive tool to improve patient care.
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