Although the use of e-mail and other Internet-based and computerized information resources has become routine in most professions, a survey of physicians across the U.S. has found that fewer than half of them incorporate these common technologies into routine patient practice. In a paper to appear in the November Journal of General Internal Medicine, now available online, investigators from Massachusetts General Hospital (MGH) report results of a 2004 survey of physicians across the country.
"We are investing tens of billions of dollars in health information technology [IT] nationally, yet the medical profession has been very slow to adopt these tools for clinical care," says Richard Grant, MD, MPH, of the MGH Division of General Medicine, the paper's lead author. "We were shocked at the very low rate of basic IT use, particularly among solo-practice and non-academic physicians. I'm sure that the vast majority of them personally use e-mail and the Internet, but most do not have effective ways to integrate these tools into clinical practice."
The current article is the first of several reports from the Institute on Medicine as a Profession Study. This survey was sent to more than 3,000 physicians in six specialties - internal medicine, family practice, pediatrics, anesthesiology, general surgery and cardiology - randomly selected from the membership in the American Medical Association. Along with questions about many aspects of medical professionalism, respondents were asked to indicate how frequently they used five information technologies: e-mail communication with patients, e-mail communication with colleagues, online access to continuing medical education, online access to scientific journals, and computerized or online texts and other information designed to support clinical decisions.
The almost 1,700 survey respondents were most likely to report commonly using computerized decision support tools and online journal access, although only about 40 percent said they used each technology frequently. Online medical education courses were frequently accessed by 24 percent of respondents. Frequent e-mail communication with colleagues was reported by 30 percent of physicians, but less than 4 percent indicated frequently communicating with patients by e-mail. Frequent use of the surveyed technologies was most likely among recent medical school graduates and physicians affiliated with academic practices and health maintenance organizations (HMOs) and was least likely in one- or two-person practices.
While the survey did not ask about reasons behind physician's low use of IT resources, the study authors cite several factors that may underlie the limited utilization. Concerns about the confidentiality of e-mail communications and the lack of reimbursement mechanisms for advice provided online were some probable barriers. The differences in IT usage associated with the types of physician practice probably indicate how the presence of systems that address some of these barriers may make a difference.
"It looks like academic centers and HMOs are leading the way in more effectively integrating information technology into clinical care," says Grant. "We need to find ways to help the practices that are lagging behind. It's not only the costs of installing new systems but also re-engineering the workflow and reimbursement structures to accommodate the latest ways of communicating. At its best, health information technology can improve communication with patients and among physicians, reduce medication errors, and support more cost-effective and evidence-based care management." Grant is an assistant professor of Medicine at Harvard Medical School.
Co-authors of the JGIM report are senior author David Blumenthal, MD, MPP, director of the MGH Institute for Health Policy; Eric Campbell, PhD, and Timothy Ferris, MD, also of the MGH-IHP; and Russell Gruen, MD, PhD, of the HSPH Department of Health Policy and Management. The study was supported by grants from the Open Society Institute's Medicine as a Profession Program and the National Institute of Diabetes and Digestive Disorders.
Massachusetts General Hospital, established in 1811, is the original and largest teaching hospital of Harvard Medical School. The MGH conducts the largest hospital-based research program in the United States, with an annual research budget of nearly $500 million and major research centers in AIDS, cardiovascular research, cancer, computational and integrative biology, cutaneous biology, human genetics, medical imaging, neurodegenerative disorders, regenerative medicine, transplantation biology and photomedicine. MGH and Brigham and Women's Hospital are founding members of Partners HealthCare HealthCare System, a Boston-based integrated health care delivery system.