Reviews of the different degrees to which industrial nations have embraced
electronic patient records show that physician involvement and support are
crucial for such programs to advance.
Recent research has found that the United States is far behind other
Western nations in its use of electronic health records, and several European
nations consistently rank among the most prolific health information
technology (HIT) users. Researchers looking for lessons to encourage more
widespread U.S. adoption of electronic records found physician support was
"What was clear in all countries was that if you wanted to move to an
electronic health records system, which brings together data from multiple
sources, it is impossible without [general practitioner] involvement,"
said Denis Protti, chair of Health Informatics at the University of Victoria
in Canada, who has studied the issue extensively. His comments came during a
Commonwealth Fund international symposium on HIT, which included the release
of a survey tracking primary care physicians' use of such technology.
The Commonwealth Fund's "2006 Health Policy Survey of Primary Care
Physicians in Seven Countries" determined that physicians in the
Netherlands, New Zealand, and the United Kingdom led international use of
electronic health records, while U.S. and Canadian physicians lagged. The 2006
survey found that 28 percent of U.S. physicians use electronic medical
records, while 98 percent of Dutch physicians do so.
Speakers at the Commonwealth Fund symposium said that the longer experience
of European countries with HIT demonstrated that although many factors
influenced the systems' success, use of these records was more pervasive if
widely embraced by physicians.
In France, for example, physicians' concerns over privacy and competition
were cited as a chief reason for that nation's more limited use of electronic
medical records. Conversely, the support of Danish physicians was described as
critical for that nation's rank among the earliest and widest adopters of HIT,
according to Protti.
Danish physicians have long been strong supporters of that country's system
because it was designed as a "point to point" communications
network to transfer patient information quickly between physicians and between
clinicians and pharmacists. The danish system has begun to encounter physician
resistance only in the last two years as the government has sought to expand
it to include a centralized "portal" that would allow broader
access to patient records.
"Unlike some other countries that have chosen to go with a single
patient record philosophy—like an electronic health record that is
shared among all of the patients' clinicians—the Danes have chosen for
the time being not to go that route," Protti said.
The centralized record approach is gaining traction in some other
countries, including Sweden and Spain, where all clinicians treating a patient
can see shared data in a patient's file relevant to their specialty.
Dutch researcher Ib Johansen said his country's approach remains popular
with physicians because they helped to design it. The quick access to patient
information, he said, allows them to locate patient records more quickly and
raise their income by providing e-mail consultations for many more patients in
the same amount of time. Additionally, most Dutch physicians support a feature
also popular with the public that allows patients to track who has viewed any
of their electronic records.
"Patients' access to their own data and treatment is the highlight of
the system," Johansen said. "Informed patients can do more when
they have access to their own data."
Protti said the ability for the public to know who has accessed their data
was critical to address privacy concerns.
The widely used Dutch digital communications system has provided a range of
benefits, Johansen said, including a reduction in laboratory mislabeling
incidents from 18 percent to 2 percent. The system's ability to notify
patients and physicians electronically about needed checkups is also credited
with a significant drop in the number of new cervical cancer cases.
The United States may improve its standing in the adoption of HIT if
federal legislation supporting it gains traction in the postelection session
of Congress. Legislators are looking to reconcile a House-passed HIT bill (HR
4157) and a bill (S 1418) the Senate passed in November 2005.
The legislation aims to make HIT more appealing to physicians by addressing
time and cultural barriers to its adoption. The Senate measure also would help
fund the purchase of such technology by authorizing $125 million for a loan
program and other efforts in the first year, $155 million in the second year,
and "such sums as necessary" through 2010.
The intent behind both bills is to speed the adoption of national standards
for data storage and sharing of medical information. They also would codify
the Office of the National Coordinator for Health Information
Technology—created by executive order in 2004—within the
Department of Health and Human Services.
Information on the Commonwealth Fund's "2006 International
Health Policy Survey" is posted at<www.cmwf.org/newsroom/newsroom_show.htm?doc_id=420192>.
HR 4157 is posted at<www.thomas.gov/cgi-bin/bdquery/z?d109:h.r.04157>;
S 1418 is posted at<www.thomas.gov/cgi-bin/bdquery/z:s.01418>.▪