Study Finds Gap Between EMR Expectations, Reality

A health care think tank says a gap exists between policymakers’ expectations that electronic medical records (EMR) can improve patient care and clinicians’ real-world experiences with EMRs. The study by the Center for Studying Health System Change was reported in HIT News.

According to the study, results of which have been published online in the The Journal of General Internal Medicine, clinicians have identified many areas where the design of EMRs could be altered and office care processes modified to improve EMR support for tasks involved in coordinating patient care.

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The study also  indicates:

  • EMRs may have unintended consequences for care coordination, such as creating information overload that complicates providers’ efforts to discern key clinical information.
  • Given the confines of the current payment system, creating incentives to adopt EMRs as they currently exist may result in EMRs being designed primarily for billing purposes rather than for clinical relevance to patients and care coordination.
  • Clinicians believe EMRs have limited ability to capture dynamic planning and the medical decision-making processes in a way that supports future coordination needs—EMRs focus on linear documentation, they say, while care coordination is dynamic and ongoing.
  • Maximizing the potential of an EMR for coordination involves ongoing evolution of clinical care processes as well as clinician input on EMR design modifications and standards for data exchange to support those processes.
  • Modifying reimbursement to encourage coordination of care by clinicians will likely drive them to demand better EMR functioning to support coordination.

While current commercial EMR design is driven by clinical documentation needs, there is heavy emphasis on documentation to support billing rather than patient and provider needs related to clinical management, the study found. Current fee-for-service reimbursement encourages EMR use for documentation of billable events—such as office visits and procedures—and not for care coordination, which is not a billable activity.

Research was partially supported by the Commonwealth Fund.

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