EMR Value Diminished If Patients Can’t Access Care

A new study from the august Commonwealth Fund has just come out, offering a portrait of primary care practices in ten countries. The study had a lot of interesting data to offer, including news of primary care reforms to meet the needs of aging populations and improve chronic disease care.

One of the key data points drawn from the CF study was that two-thirds of U.S. PCPs reported using EMRs in  2012, up from 46 percent in 2009. That’s obviously a big improvement, though the U.S. still lags behind the U.K.,  New Zealand and Australia in EMR implementations and use of IT generally.

At the same time, it seems that U.S. citizens still face serious financial obstacles in getting primary care. Fifty-nine percent of U.S. physicians surveyed said that their patients often have trouble paying for care. That’s a big contrast with other countries included in the study, including Norway (4 percent), the  U.K. (13 percent) and Switzerland (16 percent). These numbers make sense when you consider that the U.S. is the only country surveyed that doesn’t offer universal health coverage.

Putting aside humanitarian reasons to be troubled by money obstacles to PCP access, there are other issues to consider. To me, the most obvious is the selection bias imposed by financial barriers to care.

Consider one of the big goals a medical home hopes to accomplish, managing chronic conditions effectively across the primary care practice’s population.  PCPs can make great use of an EMR to work on such goals, from issuing reminders to get preventive care to tracking patient progress across different demographics to test the impact of new interventions.

The thing is, the power that is a well-tuned EMR is not at its best if the interventions are mostly aimed at those who fit a certain socio-economic profile.

Admittedly, few small PCPs need to be worried about selection bias from a scientific standpoint, as they’re seldom gunning for the next journal article presentation, but looking at the country as a whole, we’re missing out on the collective learning we can generate with clinical data analytics.  It seems to me that we’re going to have to address this problem directly if we want to leverage EMRs for the greater public good.