Interactive research shows North America slow to adopt EMR
Only 14% of Canadian & 17% of US doctors use electronic medical
records. In the UK, however, 59% of physicians use EMR.
Many experts agree on two steps that could be taken to significantly
improve the quality of care and to reduce medical errors. Both involve
the use of information technology and electronic documentation.
In both areas, North America is not moving nearly as fast as the
experts would like. Indeed, the U.S. is moving more slowly than
some other countries.
One major reason for medical errors is that different physicians
treating the same patient do not all have access to all the patient's
medical records. Different, incomplete medical records are kept
in different places. There is a near consensus that the widespread
use of electronic medical records, accessible to all those seeing
and treating a patient substantially improves the coordination and
quality of care. Another important reason for medical errors is
that most prescriptions are still written on paper, and mistakes
are made in the filling of prescriptions because they are difficult
to read or incomplete, or merely because of human error. Again there
is a near consensus that electronic prescribing would greatly reduce
prescribing errors, thereby improving the quality of care. For example,
their use would avoid many of the problems caused by drug interactions,
a cause of many hospital admissions.
While almost every expert who has written or spoken on this subject
agrees that the use of electronic prescribing and electronic medical
records would greatly reduce medical errors, implementing these
changes can be slow, difficult and expensive. In many cases there
are no financial, or other, incentives to physicians or health systems
to implement them. Research has shown that many physicians see no
benefit to themselves or their practices by moving from paper to
As a result, Harris Interactive research shows only relatively
small minorities of American physicians are using electronic records
or prescribing, and the United States lags behind other English
speaking countries in this regard. A survey of physicians conducted
for the Harvard School of Public Health and the Commonwealth Fund's
International Health Care Symposium in 2000, found that the use
of electronic systems is much more advanced in Britain, New Zealand
and Australia than in the United States. The data for Canadian usage
were also low, similar to those in the U.S. The biggest differences
between countries, by far, were in the use of electronic systems
by primary care physicians rather than by specialists.
For example, the proportions of primary care physicians who were
(sometimes) using electronic medical records were 17% in the U.S.,
14% in Canada, 25% in Australia, 52% in New Zealand and 59% in the
And the proportions of primary care physicians who were using electronic
prescribing "often" were 9% in the U.S., 8% in Canada,
44% in Australia, 52% in New Zealand and 87% in the U.K.
Differences between Primary Care Physicians and Specialists
The use of electronic medical records and electronic prescribing
was lower (mostly far lower) among specialists than among primary
care physicians, except in Canada where it was slightly higher.
Here again, however, the U.S. lags the other countries, with the
lowest proportions of specialists using either electronic medical
records or prescribing.
Why Is Usage Higher in Other Areas and Lower Here?
There is a simple explanation for these differences in the US.
In countries with national health services, or universal government-funded
health insurance, there is a single payer (whether that is the federal
or state, or provincial government). The single payer sets the rules.
If the single payer says physicians must use electronic systems,
they will do so. Furthermore, they can dictate a single nationwide
system. However that explanation does not shed light on why Canada
lags in the adotion of EMR.
The U.S., has thousands of different employer-provided health plans,
hundreds of insurers and managed care plans, and 50 state Medicaid
systems. This pluralism makes it very much more complicated, more
difficult and more expensive to introduce new electronic systems.
It seems almost certain therefore that the U.S. will continue to
trail far behind many other countries in the uses of information
technology, in spite of the consensus that they would substantially
reduce medical errors, improve the quality of care, and possibly
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