Still Significant Room for Improvement in Interoperability and Guideline Adherence As the percentage of practices using electronic health records (EHRs) for more than two years, as well as the percentage of cardiologists participating in the federal EHR Incentive Program, continues to grow, cardiologists are seeing some real benefits from EHR use, according to an ACC survey assessing the benefits and challenges associated with health information technology (IT). However, there is still room for improvement, particularly in the areas of interoperability and closing gaps in treatment and care. Compared to 2012 when two-thirds (68 percent) of cardiologists surveyed said they were operating EHRs that had been in place for at least one year, nearly eight out of 10 cardiologists (78 percent) now indicate they have been using EHRs for two years or more. More importantly, nine out of 10 survey respondents said they have a fully functioning EHR program, or are in the process of implementing one. Given this growth in use, as well as opportunities through 2015 to receive financial incentives, it’s not surprising that nearly 80 percent of respondents also said they are participating in the EHR Incentive Program – up from 58 percent in 2011. The threat of looming financial penalties is also an impetus for adoption. Physicians and hospitals that had not implemented EHRs and did not participate in the EHR Incentive Program in 2013 had until July 1 to begin participating in order to avoid a penalty in 2015. This uptake in EHR adoption has also resulted in several tangible improvements in patient safety, quality care and medication adherence. Nearly all respondents said their EHRs allowed for patient/clinical notes (95 percent), ordering of prescriptions (93 percent) and electronic tracking of patient medications (92 percent). In addition, 76 percent of those surveyed indicated their EHRs are capable of importing lab results, with 50 percent able to import imaging results. Because of these features, respondents noted that EHRs have had the greatest impact on timely access to medical records (86 percent) and prescription refills (84 percent), followed by helping to avoid medication errors (60 percent) and assisting in communication with providers (57 percent). However, respondents also highlighted several major areas for improvement. Only a little more than one out of three cardiologists (35 percent) indicated they were extremely/very satisfied with their EHR systems overall. While reliability (40 percent) and sharing of medical information (37 percent) received the highest satisfaction scores, these results were outweighed by dissatisfaction with interoperability with other software (51 percent) and integration with medical devices (55 percent). “In my opinion, all EHR systems need to have a standard platform otherwise it makes it very difficult for providers that may practice in multiple systems over time,” said one respondent. Another noted that EHRs “are very helpful, but all the demands detract from physician-patient interaction.” Moving forward, the survey data suggest there is still a large amount of work to be done if EHRs are to play a true role in improving delivery of care – either preventive or chronic illness. Finding ways to help physicians meet guideline-recommended care and communicate with patients should be key areas of focus. EHR features that allow for easy import of hospital data feeds, include reminders for guideline-based interventions and/or screening tests, and/or track patient medication adherence were less common among survey respondents and could also be a good place to start. As the ACC moves forward with implementing its Strategic Plan, partnering with EHR vendors and other health IT stakeholders to make EHR use more streamlined, interoperable and conducive to improving patient outcomes and care is a leading priority. The College intends to use the survey results to inform these actions. For more information about EHRs, as well as the EHR Incentive Program, visit CardioSource.org/HealthIT.
Published by American College of Cardiology. View All Articles.