What does the average American doctor think about health information exchange technologies, a few years into the federal government's health IT incentive program?
According to a survey sponsored by HHS's Office of the National Coordinator for Health IT, most physicians at both large and small practices are excited about leaving fax machines for streamlined clinical data exchange, but smaller practices especially say they're weary of the growing pains sometimes associated with the adoption process -- workflow interruptions, lack of connectivity to labs and specialists, and costs of the investment.
The focus groups, convened by the the University of Chicago's National Opinion Research Center in early 2012, offer a snapshot of the physician perspectives about a year or more after they had purchased electronic health record systems.
Among 68 physicians at small, large and health system-based practices in Maine, Nebraska, Texas, Washington State and Wisconsin, they tended to see different benefits to electronic exchange in part based on their size, specialist affiliations and patient needs.
Physicians in health system-owned practices noted that they had no choice in whether to participate, and doctors in large practices generally were interested in data analytics, exchange between unaffiliated practices, patient tracking, identification of drug-seeking patients and performance data for accountable care organizations.
Small practices, were mostly looking to HIEs for referrals and consults with specialists and clinical care summaries with local hospitals -- at the same time that some "note[d] their distrust of the completeness and quality of electronic records other providers send" and others were concerned about the timeliness of information in state immunization registries.
Many small practice physicians also said setting up interfaces with labs was a challenge because of cost, scarce IT resources and their lack of patient volume. Physicians working with multiple labs also had concerns with dual workflows, taking paper, fax and electronic data from different labs.
"When you have that interface directly from a lab right to your EHR, you value that relationship," a physician
from a small practice in Washington State said. "I am not really hot on my patients using outside labs because I'll eventually get the data but it will be in a paper format that gets scanned; then I have to look in at a different area of the EMR to incorporate that data. Whereas, if it comes over the interface, I can put all the values side-by-side and look for trends."
At the time of the survey, almost two-thirds of large practice physicians and half of small practice physicians were exchanging health information, although only a few physicians in hospital-affiliated practices were aware of the federal incentive program's upcoming requirements for health information exchange.
Half of small practice physicians in the focus groups receive lab results directly into their EHRs and the rest useweb portals to retrieve results, with some frustrated the lab results do not automatically flow into a patient's chart. In some cases, "staff members print results from the lab portal and then scan them into EHRs," which can render them incompatible with other records. All of the larger group practice physicians had lab results flowing directly into their EHRs, and a few had two-way exchange.