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Regards to all our listeners!

I'm Rob Logan, Ph.D. senior staff National Library of Medicine substituting this week for Donald Lindberg, M.D, the Director of the U.S. National of Medicine.

Here is what's new this week in MedlinePlus.

To listen to Dr. Lindberg's comments, click here

While a national survey suggests physicians believe storing patient health records on a computer improves quality, reduces errors, and fosters preventive patient care, less than one in five doctors use electronic medical records.

The most comprehensive study ever conducted about physicians' attitudes toward electronic health records found a paradox in attitudes. It seems that many American physicians conceptually approve the idea of using computerized patient records -- but do not adopt them within their clinical practice.

Almost 82 percent of U.S. physicians who use electronic records said they improve the quality of clinical decisions; 86 percent said they helped avoid medication mistakes, and 85 percent noted they help doctors encourage patients to prevent future illnesses. Most physicians, who use partial or comprehensive electronic medical records, reported overall satisfaction with their experiences.

Nevertheless, about two thirds of the physicians (who do not use electronic records) reported the cost to implement them was a major adoption hurdle. Some other statistically significant, stiff barriers reported by physicians who do not use electronic medical records include:

• Uncertainty about the yield of electronic medical records on a physician's time and financial investment
• Finding a electronic record system compatible with an individual practice or tailored office setting
• Concern about a loss of productivity during the transition from paper to electronic records
• Concern that an electronic medical records system will become prematurely obsolete

While these concerns reflect some no-nonsense financial reservations, some practical issues were not seen as barriers. Some less pressing issues that impede adoption include: the possibility of illegal record tampering, the legality of accepting electronic records form hospitals, and the possibility of increasing a physicians' vulnerability to litigation by computerizing patient records.

The current study, published in the New England Journal of Medicine and sponsored by the U.S. Department of Health and Human Services, suggests that physicians in small practices especially are unlikely to use electronic medical records. Less adoption also was found in office settings not attached to a hospital or a medical center, and among persons who have practiced medicine for more than 30 years. Conversely, physicians in the Western part of the U.S use electronic health records more frequently than doctors in the rest of the nation.    

These results suggest electronic medical records are perceived by physicians as better tailored to larger hospitals, clinics and practices rather to small practices (where millions of Americans receive health care).

A comprehensive (or fully functional) electronic medical record often includes a patient's complete health history, medications, health problems, and a doctor's clinical notes from recent visits. Besides these, a physician can review lab results, x-rays, MRIs, receive warnings about a patient's abnormal lab results, drug interactions, and receive a prompt when a patient needs a lab test.

We should add that many of the U.S.' largest medical groups use electronic medical records to keep track of patient information.  Among some well-known medical organizations that use electronic medical records are: The Mayo Clinic, Kaiser Permanente, Intermountain Health Care, the University of Pittsburgh Medical Center, and the Cleveland Clinic.

In early June, Time magazine published a story about the Cleveland Clinic's use of electronic medical records and discussed an additional feature that permits patients to access their clinical records and make appointments. The U.S. Veterans Administration hospitals have similar services. The Indiana Network for Patient Care even interlinks electronic health records among some Indianapolis hospitals with different ownership.

We should remind our international listeners that there is no national health care system in the U.S. Hence, there is no centralized insurance authority to require physicians to store records electronically.
          
In the survey, the number of participants and similarity of demographic characteristics in the sample to all the national physicians suggests the results may be representative of the nation's medical community.

The study's 11 authors conclude (and we quote): "the U.S.' health care system faces major challenges in taking full advantage of electronic health records to realize its health care goals" (end of quote). The authors add that the uncertainty about adoption revealed in the study contrasted with bipartisan efforts in the U.S. Congress and the White House to encourage the use of electronic medical records by physicians. 

At the time of the study's release several news organizations, including the New York Times, noted that Medicare announced a $150 million project to offer physicians incentives to switch from paper to electronic records. The project, which is scheduled to help 1,200 small practices in 12 cities, seems well-timed.

Meanwhile, MedlinePlus' personal health records health topic page provides a one stop resource to follow physician adoption issues, as well as obtain practical advice on how to maintain your own, personal health record.

A website by the American Health Information Management Association provides a guided tour of how to create a personal health record and how to discuss it with a physician.

The link, which is called 'Your Personal Health Information: A Guided Tour' is in the 'start here' section.

Other information on MedlinePlus's personal health records health topic page includes news coverage, information about specific issues (such as privacy considerations), the latest research on personal health records from leading medical journals, and MedlinePlus' related health topic pages.

To find MedlinePlus' personal health records health topic page, type 'personal health record' in the search box on MedlinePlus' home page. Then, click on 'Personal Medical Records (National Library of Medicine).'

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It was nice to be with you….