Elsevier

Health Policy

Volume 90, Issues 2–3, May 2009, Pages 239-246
Health Policy

Health information technology and physician perceptions of quality of care and satisfaction

https://doi.org/10.1016/j.healthpol.2008.10.002Get rights and content

Abstract

Objective

To examine across seven countries the relationship between physician office information system capacity and the quality of care.

Design

Multivariate analysis of a cross-sectional 2006 random survey of primary care physicians in seven countries: Australia, Canada, Germany, the Netherlands, New Zealand, United Kingdom, and United States.

Main outcome measures

coordination and safety of care, care for chronically ill patients, and satisfaction with practice of medicine.

Results

The study finds significant disparities in the quality of health care between practices with low information system capacity and those with high technical capacity after controlling for within country differences and practice size. There were significant physician satisfaction differences with the overall experience of practicing medicine by information system level.

Conclusions

For policy leaders, the seven-nation survey suggests that health systems that promote information system infrastructure are better able to address coordination and safety issues, particularly for patients with multiple chronic conditions, as well as to maintain primary care physician workforce satisfaction.

Introduction

As the practice of medicine has become more complex, it is increasingly difficult for physicians to provide the right care to patients every time without modern health information technology support. New advances in diagnosis and treatment including prescription drugs, devices, and procedures make it possible to improve patient health outcomes and quality of life. At the same time, more and more is expected of physicians. Physicians are expected to be knowledgeable about new research, follow state-of-the-art clinical guidelines, assist patients with complex health problems in navigating the health care system, oversee referral to specialists as appropriate, be proactive in ensuring that patients receive recommended preventive care and assist patients in self-management of chronic conditions [1].

Fortunately, advances in health information technology make it easier for physicians to do all these tasks: remind patients when preventive care is due, establish disease registries for monitoring appropriate care, prescribe and refill medications, order and receive results of laboratory and imaging tests, and obtain information from specialists and hospitals on care patients have received outside a primary care practice [2]. Yet, despite these advantages for providing high quality care and evidence that health information technology can improve the quality and safety of care for patients with chronic diseases such as diabetes or hypertension [3], adoption of health information technology and systems for sharing information across providers caring for a given patient has been slow and variable across practices and countries [4].

This article provides the first cross-nation information on the relationship between primary care physician information technology (IT) functional capacity and their perception of and satisfaction with the care they provide. Specifically, this article analyzes data from a seven-country survey of primary care physicians about their use of information technology and the relationship between IT capability, care coordination, quality of care, and satisfaction with the practice of medicine.

The findings underscore the importance of policies that will accelerate the spread and use of information technology and mechanisms for the exchange of health information among providers.

Section snippets

Methods and data

Data come from the 2006 Commonwealth Fund International Health Policy Survey of Primary Care Physicians, a representative survey of 6088 primary care physicians conducted by Harris Interactive in February through July, 2006 in seven countries: Australia (1003), Canada (578), Germany (1006), the Netherlands (931), New Zealand (503), United Kingdom (1063), and United States (1004). Data were collected using different methodologies, including a mix of telephone, mail, and fax. In the U.S., the

Information system functional capacity

Practice systems and information technology functional capacity is the main variable of interest. To assess overall information system functional capacity, we created a summary variable of IT and other specified tasks physicians report as computerized or “easy” with current clinical record systems. The summary variable includes a count of 14 items: uses an electronic medical record (EMR); EMR allows you to share records electronically with other doctors outside practice, access records outside

Outcome measures

We measure primary care physicians’ ability to provide quality of care in three areas including, managing chronically ill patients, patient safety, and responsiveness to patients. We also consider physician satisfaction ratings.

Practice and physician characteristics

We include practice size as the most important covariate because it is a predominant factor affecting the use of IT in some countries [9]. The survey asked the respondent how many full time equivalent (FTE) doctors are in their practice. The analysis groups practice size into three categories: 1 or fewer FTE physicians, more than 1 but less than 5 FTE physicians, and five or more FTE physicians. Physician characteristics that may affect IT capacity as well as the outcomes include gender and

Analytic approach

First, we briefly describe and compare the use of information technology across seven countries in the survey and examine the effect of practice size on overall IT capacity within each country. Next, the analysis focuses on how IT capacity affects physicians’ ability to provide quality care regardless of their age, gender, size of their practice, or in which country they practice. We estimate logistic regressions to examine the relationship between IT capacity and caring for chronically ill

Spread of IT among primary care physicians in seven nations

The spread of IT systems among primary physicians in Australia, Canada, Germany, the Netherlands, New Zealand, the United Kingdom and the U.S. is highly variable. The use of electronic medical records ranges from nearly all physicians in the Netherlands to only 23% and 28% in Canada and the U.S., respectively (Exhibit 1).

Other IT system functionalities include electronic ordering of tests, prescribing of medication, access to test results and access to hospital records. The widespread use of

Conclusions

The health care sector has been a laggard in adoption of information technology in comparison to other industries [14]. Physicians have been concerned about finding the resources and time required to change their office practice systems, and uncertain about the utility of doing so [15]. Yet, the potential benefits of information technology to the health system are clear. Findings indicate that greater IT functionality or enhanced office IT systems is associated with physicians’ feeling well

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