Electronic Medical Records

Health information technology has astounding potential to improve the delivery and management of health care by improving quality, streamlining clinical practice, and providing portability of medical data. However, estimates of physician uptake of electronic medical records remains low – estimates from 9 to 29%.

The authors of the present study evaluated four domains of electronic health records: (1) recording patients clinical and demographic data, (2) viewing laboratory and imaging results, (3) physician order entry, and (4) clinical decision support. Sixty-two percent of eligible physicians, (derived from the American Medical Association master file and those practicing in ambulatory practices) completed surveys.

Employers (n=609, response rate 64%) representing 41 major U.S. markets, each having greater than 50 employees and situated in areas with a minimal level of HMO market penetration, were randomly selected for interviews to determine the proportion of employers influenced by health quality data when selecting health plans.

Only a mere four percent of physicians have a fully functional electron medical records system, while 13% have a basic system. Of those with EMR, the majority (71%) are integrated with the hospital to which the physician has admitting privileges

The physicians most likely to have EMR were more often younger, worked in larger practices, worked in hospitals/medical centers, or resided in the Western United States. Among those physicians who did not have EMR, several barriers to uptake were identified, including cost, concerns of record tampering, and concerns that the system might quickly become obsolete.

Commentary:

Electronic medical records have astoundingly low uptake among ambulatory care practitioners. In order to improve such uptake, physicians will need to discover solutions to defray cost, government and EMR vendors will need to assure privacy for patients and that systems will be adaptable to future advances.
NEJM 2008; 359:50-60.