Survey shows decline in EMR use by Australian GPs

Written by Kate McDonald on .

A survey of 500 Australian general practitioners has found a slight decline in the use of electronic medical records over the last three years.

The survey, part of a major study of health IT use and access to medical care in 10 countries carried out by the US-based private charitable foundation the Commonwealth Fund, found that 92 per cent of Australian GPs used an EMR in the survey period, down from 95 per cent in 2009.

New Zealand remained the same, with 97 per cent of 500 GPs surveyed reporting using an EMR.

The survey authors say that for a sample of this size, the margin of error is plus or minus two to four per cent, which might explain the decline.

Lesley Russell, a senior research fellow at the Australian Primary Health Care Research Institute, described the findings as "embarrassing and puzzling" in a recent article in The Canberra Times.

Dr Russell told Pulse+IT that the government and professional bodies should not ignore the finding but ask why. "I thought about sampling error, and it might be that, but the Commonwealth Fund is known for the reliability of their work," she said.

"I think that there is an issue in Australia about interconnectivity. My belief is that this is due to a number of issues – the failures of the current IT systems out there, patients not pushing for this, health professionals not understanding how much of a difference this could make to patient management and patient outcomes, and the fact that too often they only do what they are incentivised to do."

The survey, of nearly 8500 primary care physicians in Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Switzerland, the UK and the US, also found that a minority of primary care doctors reported always receiving timely information from specialist physicians after referring patients to them.

It also found a wide disparity in patient access to doctors using electronic means, with Australia trailing the field in allowing patients to book appointments or referrals online or ask for prescription refills online.

Five of the 10 countries – Australia, New Zealand, the UK, Norway and the Netherlands – reported almost universal EMR use by primary care doctors. Germany showed an increase from 72 per cent in 2009 to 82 per cent, and the US from 47 per cent to 69 per cent.

Commonwealth Fund president Karen Davis said she believed the substantial increase in US doctors’ use of EMRs was a reflection of the financial incentives and national investment in that country's 2009 economic stimulus legislation.

Surprisingly, only 56 per cent of Canadian doctors use electronic medical records, as do 41 per cent of Swiss doctors. France saw no growth from 2009, when it registered 68 per cent.

At the Commonwealth Fund's recent International Symposium on Health Care Policy, the survey's authors, Cathy Schoen and Robin Osborn, also released details of patient access to and communications with GPs by electronic means.

It showed that very few Australian GPs allowed patients to request appointments or referrals online, with just eight per cent of practices allowing this. In New Zealand it was 13 per cent, compared to 40 per cent in the UK and 66 per cent in Sweden (which was not surveyed for EMR use).

The RACGP's spokesman on eHealth, Mike Civil, said he was not aware of any desktop packages that include online appointment systems. "There are some external software packages that can work with your desktop system to do online requests, but they do not access the clinical software directly and so I have always felt them to be less attractive as a system choice," Dr Civil said. "But there certainly seems to be a move in that direction, which would be a great step."

Seven per cent of Australian practices allowed patients to request refills of prescriptions online, compared to 25 per cent in NZ, 56 per cent in the UK and 88 per cent in Sweden. Dr Civil said some Australian practices will accept emailed requests for repeat scripts but that is the only way he is aware that software packages could cover an online request.

"Of course a simpler solution would be a software package that had calculated that a patient was due their repeat script and then “asked” the clinician if they wanted the computer system to do those repeat scripts that were due, ready for signing and delivery to the patient," he said.

Australian doctors were also reluctant to accept email questions about medical matters from patients, with 20 per cent of practices allowing it. This was reflected throughout the survey, with none of the 11 countries surveyed registering more than 50 per cent of doctors accepting emailed questions.

Dr Civil said this practice was not actively encouraged as few doctors had the time to respond to emailed questions. "Work load pressures would limit this and also the potential for not being able to gauge the patient's understanding of what you were trying to explain," he said.

"[It is] much better to be in a face-to-face scenario to cover the key medical issues with regard to medical education of a patient. We, like a lot of practices, have links to patient information websites on our practice website."

Australian and Kiwi GPs also reported a lack of timely information from specialists. In Australia, only 32 per cent of GPs said they always received a report with all relevant health information after their patient visited a specialist. Only 30 per cent received information about changes to patients' drugs or care plans, and only 13 per cent said they received information that was timely and available when needed.

For New Zealand, the figures were 41, 44 and 15 per cent respectively.

The survey findings will be published in the December issue of the Health Affairs journal, and are available online at the Commonwealth Fund's website.

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