A gap exists between policymakers' expectations that electronic medical records can improve coordination of patient care and clinicians' real-world experiences with EHRs, according to a study by the Center for Studying Health System Change.

The study, published online in The Journal of General Internal Medicine and supported by The Commonwealth Fund, indicates ambulatory care EHRs facilitate care coordination in a practice by making information available at the point of care, but are less helpful for exchanging information across physician practices and care settings.

“The average EHR is not designed for care coordination,” said Mark R. Anderson CEO of the healthcare technology advisory and research firm AC Group, Inc. He says unless practices are sharing data via a health information exchange there is no care coordination via EHRs.

The study reported that while current commercial EHR design is driven by clinical documentation needs, there is a heavy emphasis on documentation to support billing rather than patient and provider needs related to clinical management.

Rosemarie Nelson, a principal of the MGMA Health Care Consulting Group, disagrees, but says perhaps because of billing regulations organizations take more measures to document visits supporting the coding/billing.

“Vendors try to state that the EHR will improve billing, said Anderson, “but they have no data to back up their claims.”

Ed Hammond, director, Duke Center for Health Informatics, envisions a future where this could change.

“Ideally, future EHRs will have the reimbursement algorithms embedded in the EHRs and reimbursement – including approvals – would be done in real time.  The savings would be tremendous.  At Duke these savings would be around $30 million annually,” he said.

The study reported that clinicians believe EHRs have limited ability to capture dynamic planning and the medical decision-making processes in a way that supports future coordination needs.

“The frustration for clinicians in the concept of the ability to ‘capture dynamic planning’ is a reflection of the EHR products' design that doesn't readily support the patient with multiple problems (i.e. diabetes and hypertension)…Nelson said. “Many EHR products fall short in being able to easily handle this and not make the provider spend additional time ‘re-documenting.’”

“Most errors and lack of value of the EHR result from poor system design or misuse…I do believe that a correctly designed EHR can make a significant improvement – eliminating inconsistencies, errors, improper treatment and redundancy to name a few,” said Hammond.

According to the study’s authors, in order to maximize the potential of EHRs for care coordination there must be clinician input on EHR design modifications and standards for data exchange to support those processes.

"This work emphasizes that improving care coordination will not happen with technology alone," said Commonwealth Fund Vice President Anne-Marie Audet, MD. "What is needed is a redesign of care processes and workflow; clinicians will also need to adopt new ways of working and communicating within practices and across organizations."

But Nelson says clinicians are often too busy to do this.