While U.S. leads in IT tools for patients, primary care doctors still struggle to coordinate care

While the U.S. leads in aspects of health information technology, its primary care physicians still struggle to coordinate patient care and communicate with other health and social service providers, according to a new study.

The study, published in Health Affairs, looks at how the United States’ primary care health system stacks up with 11 other high-income countries.

The survey of more than 13,200 primary care physicians in 11 countries (Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom and the United States), finds U.S. doctors are challenged to coordinate specialty care and social services for patients.

Key findings from the Commonwealth Fund's International Health Policy Survey include:

  • A failure to communicate with specialists. Only 49% of U.S. primary care doctors said they communicated with their patients’ specialists. In contrast, at least 70% of physicians in Norway, France and New Zealand receive information from specialists about changes to their patients’ medications or care plans. Only one-third of U.S. doctors said they usually received timely reports from specialists within one week of consultation.
  • A lack of coordination with social services. Roughly 4 in 10 physicians in the U.S. (40%), Australia (38%) and Canada (42%) routinely coordinate with patients’ social service and community providers over issues such as housing and meals.

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  • Progress and failures of IT. Physicians from the U.S. and Sweden lead in their use of patient portals to provide appointment scheduling, prescription refills, test results and visit summaries. However, only about half of U.S. doctors say they are able to use IT to exchange lab tests and patient information with physicians outside their practice.
  • Lack of extended access to primary care. The U.S. was an outlier in not providing care outside the office, as only 37% of U.S. physicians said they or a healthcare professional in their practice made home visits frequently or occasionally, compared to 70% or more in all of the other countries. Practices in the U.S. and Canada were also unlikely to provide after-hours care where a patient can be seen by a doctor or nurse when the practice was closed, without having to visit an emergency room. In contrast, 90% or more of physicians in Germany, the Netherlands, New Zealand and Norway report having arrangements for after-hours care.

This lag in performance among U.S. primary care physicians comes after 10 years of investment in health IT and electronic health records (EHRs) and a $35 billion infusion as result of the Health Information Technology and Economic and Clinical Health (HITECH) Act under the American Recovery and Reinvestment Act, which kicked off the widespread digitization of healthcare.

While improved technology can help close some of these gaps, the study authors said successful countries have a strong commitment by government and other payers to primary care, as well as the development of innovative care models and active cooperation among healthcare and social services professionals.

An analysis by the Patient-Centered Primary Care Collaborative released earlier this year found states that spend more on primary care have better patient outcomes, including fewer hospitalizations and emergency department visits.