Access to Health Technology Sets Psychiatrists Apart

More than half of psychiatrists have access to information technology (IT) to identify treatment alternatives for their patients, but their IT access for other functions of their practice lags far behind other physicians, according to a study released in September.

A national study by the Center for Studying Health System Change (HSC) found that practice setting and size were the strongest predictors of the availability of clinical IT to physicians. However, different types of clinicians had significant variation in their IT adoption.

“Clinical IT has the potential to improve coordination of care and support quality improvement and reporting activities, but this study makes it clear that there's wide variation across physician specialties and that may hinder progress in harnessing IT to improve care,” said Paul Ginsburg, president of HSC, a nonpartisan research organization funded primarily by the Robert Wood Johnson Foundation.

The study examined whether physicians had access to information technology in their practices for the following five clinical activities: obtaining information about treatment alternatives or recommended guidelines; accessing patient notes, medication lists, or problem lists; writing prescriptions; exchanging clinical data and images with other physicians; and exchanging clinical data and images with hospitals.

Physicians with access to IT for all five clinical activities were considered to have an electronic medical record (EMR).

The study found significant variation in health IT availability across primary care, medical specialty areas, and surgical specialties. Primary care physicians lagged behind specialists in IT access for two activities, accessing notes and exchanging data with other physicians.

The study findings are based on HSC's nationally representative 2004-05 Community Tracking Study Physician Survey, which contains responses from more than 6,600 physicians and had a 52 percent response rate.

Psychiatrists were substantially less likely than a comparison group of other medical specialists to have access to IT for all activities except writing prescriptions. In contrast, oncologists were much more likely than the comparison group to have access to IT for guidelines and exchanging data with hospitals and physicians.

Psychiatrists Show Low Usage

The study found that 52 percent of psychiatrists were in practices that used information technology to obtain information about treatment alternatives or recommended guidelines, compared with 65 percent of all physicians.

Thirty-six percent of psychiatrists had access to IT for viewing patient notes, medication lists, or problem lists, while 50 percent of all physicians had health IT available for that purpose.

Psychiatrists' access to IT was most similar to the physician average in the category of prescription writing. Twenty percent of psychiatrists had IT for submitting prescriptions, which mirrored the 22 percent of all physicians who had such access.

Digital information systems were available to 34 percent of psychiatrists to exchange clinical data and images with other physicians, while about 50 percent of all types of physicians could access health technology to accomplish that.

Exchanging clinical data and images with hospitals was available through health IT by 34 percent of psychiatrists compared with 66 percent of all physicians.

Twelve percent of all physicians had access to health IT to perform all five of the tasks tracked by the study, while only 2 percent of psychiatrists had access that was that extensive.

“The importance of particular clinical activities to a specialty may affect IT adoption across physician specialties,” said Catherine Corey, M.S.P.H, coauthor of the study, in a written statement. “For example, surgeons may have less need for IT to write prescriptions since they typically prescribe a narrow range of on-formulary medications on a short-term basis in contrast to medical specialists and [primary care physicians] who treat chronically ill patients taking multiple medications.”

In other cases, existing electronic medical record products may not meet the distinct clinical needs of some specialties, such as enhanced drawing features and imaging storage for ophthalmologists monitoring glaucoma patients or growth-tracking capabilities and pediatric dosing calculations for pediatricians, the authors noted.

They cautioned that the findings are considered an upper limit on the proportion of physicians regularly using clinical IT in their practices. This was because physicians were asked only about IT availability in their practice but not whether they actually use the technology or the frequency or intensity of use.

The study highlights the continuing lag by physicians in adopting information technology. Although there are many reasons why physicians have been slow to invest in electronic medical records, according to John Luo, M.D., former president of the American Association for Technology in Psychiatry, concerns by physicians about the security of health information exchanges may be one of the biggest. He pointed out that unlike other areas of e-commerce, health care technology vendors have yet to agree on a standard for information exchange.

Another factor delaying adoption is the lack of national standards for electronic health care transactions, although the Health Insurance Portability and Accountability Act of 1996 (HIPAA) required their development.

The lack of financial incentives for adopting electronic medical records and legal concerns—such as laws in some states that prohibit hospitals from giving technology to their referring physicians—also stand in the way of achieving its broader adoption, Luo noted in a 2006 column in Primary Psychiatry.

Information on HSC's Data Bulletin, “Clinical Information Technology Adoption Varies Across Physician Specialties,” is posted at</www.hschange.org/CONTENT/945/>.▪