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.

About the author

Anne Zieger

Anne Zieger

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.


  • Healthcare is not a “right”. Therefore, government has no constitutional power to levy a tax to provide it for the “greater good.” Read the Bill of Rights, you will not find healthcare listed there – even though healthcare was available at the time it was written.

    Moral people should not fear death – and health care should be metered for those who can pay for it. I should not be entitled to the same level of care as Bill Gates.

  • Between long term unemployment and employers who don’t provide viable coverage to many or even all employees, many people can’t afford medical care. Consider that an annual checkup can cost hundreds, and a visit for illness almost as much – plus badly overpriced medications, and far too many Americans are ineligible for Medicaid and like programs. When you have little income, you do without most medical care, including preventative. There is no way that EMR’s help that situation.

    As to Miguel’s nasty comments, most people are not looking for a luxury suite in the hospital. But society is far better off with a healthy population. Countries with universal medical coverage have a far lower cost for care then in the US. I’d like Miguel to imagine the what if an epidemic hits his area, and people before they die spread the illness to his family, who die as a result. My guess is that extremists like him will only understand this when it hits them personally.

  • @R Troy

    If we were healthy we would not need a doctor. Get government out of the picture and the prices will drop because hospitals will have to live within their means, without being subsidized by the “healthy.”

    GMO and the FDA are prime examples of the reasons for higher costs in healthcare and medications. Clean up governmental waste and scientific, public experiements and be surprised at the results. Less government = better society.

  • That is far and beyond absurd. We need good preventative care to stay healthy – and that takes doctors. If hospitals had no government help, our population would be rapidly dropping due to untreated sick people and epidemics. If you want less government, buy yourself an island somewhere and move to it. Your hate for the poor and the sick is in itself sickening.

  • anupamroy,
    I’d say for the forseeable future. Although, the position is changing to more of an edit function and even some clinical processing as opposed to strict transcription.

  • Dear John
    I was expecting the word “unforeseeable”, but say after 2015 will it exist even in the form of editing? I have come to know that ICD 10 will give lot of employment IN USA?

  • I think that it will still be around well after 2015. Many thought that EMR software would do away with transcription, but many are finding that transcription can be a more efficient way to work even in an EMR world. So, I expect it will stick around for a while.

  • what about billing and coding career, someone told me that it unfolds huge opportunity in the future?

  • This is true. I’ve talked to the coding and billing associations and their skills are still highly sought after. Considering our complex billing environment in healthcare, I’m sure this will continue to be a major need.

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