By John Reichard, CQ HealthBeat Editor
November 3, 2006 -- One reason U.S. primary care physicians trail their counterparts abroad in the use of information technology (IT) is they need help paying for it, health care analysts say. Yet government funding for IT is a factor explaining high use rates in only five of the 10 nations whose IT use exceeds that of the United States and Canada, according to study results released Friday at an international health care conference on Capitol Hill.
The 10 countries in the study were Denmark, Scotland, New Zealand, Sweden, England, the Netherlands, Australia, Norway, Austria, and Germany.
Canadian researcher Denis Protti, who conducted the study, spoke on the third day of the three-day conference sponsored by the Commonwealth Fund and the nonpartisan Alliance for Health Reform.
Protti, a professor of health information science at the University of Victoria in British Columbia, said Denmark is by far the most advanced nation among the 10 in physician use of IT. But neither Denmark nor four other nations among the 10—Austria, Germany, New Zealand, and Norway—have reached their advanced status because of government funding, he said.
Denmark was particularly noteworthy among the 10 because of its pace-setting performance and its self-financed IT purchases among general practitioners (GPs). "There has been no direct funding to GPs investing in electronic medical records and electronic communication," said Ib Johansen, deputy manager of MedCom, the public–private entity in Denmark responsible for promoting use of IT by the nation's physicians.
The use of IT by physicians in Denmark historically has been voluntary, with use of computers mandated for the first time only two years ago, Johansen said. Ninety-nine percent of general practitioners in Denmark have computer systems now, but use of IT is not a recent phenomenon. According to the data presented by Protti, more than half of Danish general practitioners in 1994 were using electronic medical records.
"Virtually all GPs and specialists use a secure, national communications network to electronically send and receive clinical messages such as prescriptions, lab results, lab requests, discharge summaries, referrals, etc.," Protti said.
GPs enter prescriptions electronically, in most cases getting "decision support" in terms of warnings if a prescription might cause an adverse reaction because of another drug the patient is taking or warnings not to prescribe a drug if a patient is pregnant.
Once the doctor decides on a prescription, he or she "selects that patient's pharmacy from a pull-down menu," Johansen noted. The prescription then is sent electronically to the specific pharmacy.
Both providers and patients can see lab results online over the Internet, he added. They also can see a list of medications the patient takes, get information on waiting lists at various facilities, schedule appointments, renew prescriptions, and communicate by e-mail.
Why are doctors willing to foot the bill for IT? Efficiency, higher revenues, and peer pressure are all factors, Johansen said. "The major reason Danish physicians use their computer is because of the communication benefits it brings them," Johansen said. Instead of waiting five days for test results from a hospital, "they now receive them almost as soon as they come off the equipment," he said.
They also receive automatic notifications when a patient is registered in an emergency department. Hospital reports on discharged patients arrive within two days rather than four weeks or more. Prescription refills can be ordered quickly. "A process that used to entail having to pull charts and handwrite a [prescription] now takes 10 seconds."
Peer pressure enters into acceptance of IT, Johansen added. GPs meet regularly in "clubs" they form to discuss issues relating to medical practice and the talk creates pressure to become more efficient through use of IT, he said.
But if GPs aren't getting direct aid to buy technology, they do receive other government assistance. Doctors can bill for treatment of more patients because they can include e-mail consults. "On average, GPs have experienced a 20 percent increase in the number of consultations after beginning use of electronic medical records and electronic communications," Johansen said. And data consultants funded by local jurisdictions help doctors integrate IT into their practices.
Other outcomes of wider IT use are lower costs and saved lives, he added. IT has fostered greater use of lower-cost medications and a reduction in cervical cancer deaths because of greater screening efficiency, Johansen said. Deaths from the disease have fallen by more than half between 1988 and 2004, he said.
One of the factors easing patient worries about the privacy of their data is they are able to see on their computer screens which providers access their medical records, Johansen said. Protti said another reason IT has caught on so well among Danish doctors is its first applications were specifically those that benefited physicians, such as provider-to-provider communications. And privacy worries aren't as great because medical data—imaging results and prescription drug data, for example—are in different databases and not all in one electronic health record.
The move from "electronic medical records," in which data may be in different places, to electronic health records, in which it is all in one place, will lead to greater privacy worries, he suggested.
Protti said there is no single reason why the 10 countries have such a high use of IT. Requirements or incentives for electronic billing were "an influencing factor" in five of the 10. And government financial support to buy IT did play a role in half of the countries, but varied from modest one-time grants in Australia to programs in Sweden and Scotland where the county—equivalent to a province—"pays for everything."
"Clearly the role of government health policy played a part in most of the countries," Protti added. Financial incentives to automate as distinct from direct payments for purchases also were a factor. Accreditation of vendor systems, common IT standards, and consulting support to GPs also were important factors, he concluded.