Improving coordination of medical care will not happen with technology alone as a new study finds that current commercial electronic medical records (EMRs) are better for billing and documentation needs than physicians’ clinical needs.

EMRs facilitate care coordination within a practice by making information available at the point of care, but are less helpful for exchanging information across physician practices and care settings, found a study by the Center for Studying Health System Change.

While current commercial EMR 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, according to the research. Current fee-for-service reimbursement encourages EMR use for documentation of billable events—office visits, procedures—and not for care coordination, which is not a billable activity.

 “There’s a real disconnect between policy makers’ expectations that current commercial electronic medical records can improve care coordination and physicians’ experiences with EMRs,” says Dr. Ann O’Malley, senior researcher with HSC, and coauthor of the study.

The study is based on 60 interviews, including 52 physicians, at 26 small- and medium-sized physician practices with commercial ambulatory EMRs in place for at least two years.

Other key findings include:

• EMRs may have unintended consequences for care coordination, such as creating information overload that complicates providers’ efforts to discern key clinical information.
• Modifying reimbursement to encourage coordination of care by clinicians will likely drive clinicians to demand better EMR functioning to support coordination.
• Simply creating incentives to adopt EMRs as they currently exist may result in EMRs being designed primarily for billing purposes rather than for clinical relevance to patients and care coordination.

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