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Physicians slow to integrate information
technology into patient practice
Less than half frequently use e-mail,
Internet resources for clinical information, communication
BOSTON - October 2, 2006 - Although the use of e-mail and
other Internet-based and computerized information resources has
become routine in most professions, a survey of physicians across
the U.S. has found that fewer than half of them incorporate these
common technologies into routine patient practice. In a paper to
appear in the November Journal of General Internal Medicine,
now available online, investigators from Massachusetts General Hospital
(MGH) report results of a 2004 survey of physicians across the country.
"We are investing tens of billions of dollars in health information
technology [IT] nationally, yet the medical profession has been
very slow to adopt these tools for clinical care," says Richard
Grant, MD, MPH, of the MGH Division of General Medicine, the paper's
lead author. "We were shocked at the very low rate of basic
IT use, particularly among solo-practice and non-academic physicians.
I'm sure that the vast majority of them personally use e-mail and
the Internet, but most do not have effective ways to integrate these
tools into clinical practice."
The current article is the first of several reports from the Institute
on Medicine as a Profession Study. This survey was sent to more
than 3,000 physicians in six specialties - internal medicine, family
practice, pediatrics, anesthesiology, general surgery and cardiology
- randomly selected from the membership in the American Medical
Association. Along with questions about many aspects of medical
professionalism, respondents were asked to indicate how frequently
they used five information technologies: e-mail communication with
patients, e-mail communication with colleagues, online access to
continuing medical education, online access to scientific journals,
and computerized or online texts and other information designed
to support clinical decisions.
The almost 1,700 survey respondents were most likely to report commonly
using computerized decision support tools and online journal access,
although only about 40 percent said they used each technology frequently.
Online medical education courses were frequently accessed by 24
percent of respondents. Frequent e-mail communication with colleagues
was reported by 30 percent of physicians, but less than 4 percent
indicated frequently communicating with patients by e-mail. Frequent
use of the surveyed technologies was most likely among recent medical
school graduates and physicians affiliated with academic practices
and health maintenance organizations (HMOs) and was least likely
in one- or two-person practices.
While the survey did not ask about reasons behind physician's low
use of IT resources, the study authors cite several factors that
may underlie the limited utilization. Concerns about the confidentiality
of e-mail communications and the lack of reimbursement mechanisms
for advice provided online were some probable barriers. The differences
in IT usage associated with the types of physician practice probably
indicate how the presence of systems that address some of these
barriers may make a difference.
"It looks like academic centers and HMOs are leading the way
in more effectively integrating information technology into clinical
care," says Grant. "We need to find ways to help the practices
that are lagging behind. It's not only the costs of installing new
systems but also re-engineering the workflow and reimbursement structures
to accommodate the latest ways of communicating. At its best, health
information technology can improve communication with patients and
among physicians, reduce medication errors, and support more cost-effective
and evidence-based care management." Grant is an assistant
professor of Medicine at Harvard Medical School.
Co-authors of the JGIM report are senior author David Blumenthal,
MD, MPP, director of the MGH Institute
for Health Policy; Eric Campbell, PhD, and Timothy Ferris, MD,
also of the MGH-IHP; and Russell Gruen, MD, PhD, of the HSPH Department
of Health Policy and Management. The study was supported by grants
from the Open Society Institute's Medicine as a Profession Program
and the National Institute of Diabetes and Digestive Disorders.
Massachusetts General Hospital, established in 1811, is the original
and largest teaching hospital of Harvard Medical School. The MGH
conducts the largest hospital-based research program in the United
States, with an annual research budget of nearly $500 million and
major research centers in AIDS, cardiovascular research, cancer,
computational and integrative biology, cutaneous biology, human
genetics, medical imaging, neurodegenerative disorders, regenerative
medicine, transplantation biology and photomedicine. MGH and Brigham
and Women's Hospital are founding members of Partners HealthCare
HealthCare System, a Boston-based integrated health care delivery
system.
Media Contact: Sue
McGreevey, MGH Public Affairs
Physician Referral Service: 1-800-388-4644
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