Comparison of information technology in general practice in 10 countries
Review: Different Strokes for Different Folks, or No Clear Pattern in Factors Facilitating EHR Adoption by GP Offices in 10 Surveyed Countries.
Protti D. Comparison of information technology in general practice in 10 countries. Healthc Q. 2007;10(2):107-16.
The article presents the results of the study conducted in 2005. It provides a comparative analysis of use of electronic records and electronic communication in general practitioner offices in 10 countries (Australia, Austria, Denmark, England*, Germany, the Netherlands, New Zealand, Norway, Scotland* and Sweden).
According to the author, the purpose of the study was to identify “governmental, professional, technological and other factors contributing to the success of the 10 surveyed countries in achieving high levels (>90%) of automation” in general practitioner offices. While office “automation” (i.e., computerization, used as the main criterion for country selection) is a rather broad term, the author’s primary focus is actually on the use of electronic records and electronic communication by general practitioners, and identifying the factors facilitating EHR adoption by the GP community in each surveyed country.
Data sources and methodology:
Details of GP systems were assessed through a combination of document reviews (scientific literature, OECD, government, and professional association reports and web sites) and personal interviews (with GPs, ministerial and vendor representatives) conducted in 2005. “As a result, data quality ranged from very robust and trustworthy to ‘estimates’ based on small sample sizes.”
Over 95% of the GP offices/clinics in nine of the countries have computers, which they use for clinical purposes. Surprisingly, the country slightly lagging behind (at 90%) is Germany.
The most common clinical application is the automation of medication prescriptions, even though it is not a mandatory requirement in all countries but Norway. Electronic prescribing provides the most benefit to general practitioners, as it addresses legibility concerns, can be a significant time saver (particularly for repeat prescriptions) and offers the potential to make use of decision-support capabilities.
The transmission of laboratory results is the most common electronic clinical communication application, with at least 50% of lab results transmitted to physicians electronically in eight out of 10 countries.
Overall, all ten countries have similar practices for hands-on care delivery, but health care financing, governance and regulatory systems varies significantly.
The study attempted to evaluate the strength of the following driving forces in the “evolution of primary care computing”:
• Government funding support
• Electronic billing mandate
• College or Association leadership
• Peer Influence
• Accreditation of vendor systems
• Non-financial support received
However, no solid pattern emerged, since the results for each factor varied widely. In Denmark, apparently the most advanced country in terms of EHR adoption, closely followed by Norway, GPs did not receive government funding support, nor were required to use electronic billing. Nevertheless, the author concludes that overall government health policies, along with the presence of some single unifying authority, are more likely to influence the computerization of primary care.
No single factor or simple combination was responsible for IT uptake and EHR adoption across all ten countries. The author concluded that government health policies, though not always directly related to IT, appear to play important roles along with the presence of some single unifying authority. Size, nomenclatures and communications standards were significant additional promoters.
Source of funding: The study was commissioned by Canada Health Infoway (an non-profit organization whose members are Canada's 14 federal, provincial and territorial Deputy Ministers of Health promoting the use of electronic health information systems and electronic health records (EHRs) across the country).
For correspondence: Denis Protti, School of Health Information Science, University of Victoria, British Columbia, Canada, firstname.lastname@example.org.
*The study and the article treat England and Scotland as two different countries.
Alexey Panchenko, MBA, MS
NLM Fellow, OHSU, DMICE