The use of Health Information Technology (HIT) in primary care practice has undergone enormous changes in recent years. One of the most significant shifts has been in the use of electronic health records (EHRs), which are digital versions of the previously used paper charting system. Almost 97% of American Board of Family Medicine (ABFM) Diplomates report using an electronic health record.

EHR Advancing Patient Care

EHR technology may be used to facilitate reporting of patient outcomes data for quality-based contracting, such as for a CMS Medicare Accountable Care Organization (ACO) population, or for general population health, such as outreach for chronic disease management or preventive health measures. The majority of surveyed family physicians report that their practice has the capability to generate a registry of patients with a given diagnosis (81.4%) and a registry of services patients are due to have (82.9%).

HIT encompasses communications between the primary care physician and patients, including patient data access through a portal and secure messaging. Eighty-five percent of family physicians work at practices that have the capacity to exchange secure messages with patients. Of this group, 1 in 3 report that they exchange messages with patients at least 5 times a day (33.4%).

HIT is not only useful for patient-provider communication, but is also a promising tool for chronic disease care coordination and continuity of care. For instance, if a patient were to start on a new dose of hypertension medication, home blood pressure readings can be documented and uploaded to the EHR for provider review. Of surveyed physicians, 34.6% report that their practice has the capability for patients to add patient-generated health data into their EHR records.

TABLE 13. Reported Electronic Health Record Capabilities in Family Practices

EHR Information Exchange

Interoperability promotes data sharing between health care provider settings, including primary care, medical specialists, and inpatient care. In 2011, the Centers for Medicare & Medicaid Services (CMS) developed a program of EHR interoperability – establishing priority of goals such as quality, safety, efficiency, care coordination, patient engagement, and medical record privacy and security in the implementation of EHR programs.³⁷ While some primary care practices engage in health information exchanges and can share data between medical providers in a certain state or geographic region, gaps in care coordination still exist due to variable EHR platforms and structural and procedural limitations.

Seventy-one percent of family physician respondents have the capability to electronically receive a summary of care from a hospital or specialist outside of their own medical group. However, of this group that has the capability, almost 30% report that they never receive the summaries or only receive them less than half of the time. For transmitting a summary of care to another provider outside of the medical group, only 54.1% report that they have the capability to create and electronically send such summaries. For those that do have the capability, the majority (54.5%) report resending these summaries of care to hospitals/specialists more than half the time.

TABLE 14. Reported Electronic Health Record Exchanges in Family Practices

TABLE 15. Reported Electronic Health Record Documentation Burden by Family Physicians

EHR Documentation Burden

Although advances in HIT have brought about unprecedented opportunities in data sharing and quality evaluation, implementation has at times presented serious challenges at the physician or practice level. Accordingly, ABFM asks survey respondents not just about the use of HIT in the clinical settings in which they work, but also about their own proficiency with these technologies and their level of satisfaction with them. Over 50% of ABFM Diplomates surveyed report that the amount of time they spend on the EHR at home is moderately high or excessive. While the plurality of respondents report “Good” EHR proficiency (49.2%), only 17.9% have “Optimal” proficiency, 27% report “Satisfactory” proficiency, and 5.2% report “Marginal”.