Survey of electronic veterinary medical record adoption and use by independent small animal veterinary medical practices in Massachusetts

• Autores: Lauren M. Krone
• Localización: JAVMA: Journal of the American Veterinary Medical Association, ISSN-e 0003-1488, Vol. 245, Nº. 3, 2014, págs. 324-332
• Idioma: inglés
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• Resumen

  • Objective—To estimate the proportion of independent small animal veterinary medical practices in Massachusetts that use electronic veterinary medical records (EVMRs), determine the purposes for which EVMRs are used, and identify perceived barriers to their use.

    Design—Survey.

    Sample—100 veterinarians.

    Procedures—213 of 517 independent small animal veterinary practices operating in Massachusetts were randomly chosen for study recruitment. One veterinarian at each practice was invited by telephone to answer a hardcopy survey regarding practice demographics, medical records type (electronic, paper, or both), purposes of EVMR use, and perceived barriers to adoption. Surveys were mailed to the first 100 veterinarians who agreed to participate. Practices were categorized by record type and size (large [≥ 5 veterinarians], medium [3 to 4 veterinarians], or small [1 to 2 veterinarians]).

    Results—84 surveys were returned; overall response was 84 of 213 (39.4%). The EVMRs were used alone or together with paper records in 66 of 82 (80.5%) practices. Large and medium-sized practices were significantly more likely to use EVMRs combined with paper records than were small practices. The EVMRs were most commonly used for ensuring billing, automating reminders, providing cost estimates, scheduling, recording medical and surgical information, and tracking patient health. Least common uses were identifying emerging infectious diseases, research, and insurance. Eleven veterinarians in paper record–only practices indicated reluctance to change, anticipated technological problems, time constraints, and cost were barriers to EVMR use.

    Conclusions and Clinical Relevance—Results indicated EVMRs were underutilized as a tool for tracking and improving population health and identifying emerging infectious diseases. Efforts to facilitate adoption of EVMRs for these purposes should be strengthened by the veterinary medical, human health, and public health professions.

    Electronic veterinary medical records are tools designed and used for health documentation and business functionalities, similar to the purposes for which EMRs are used in human medicine. Use of EVMRs is intended to maximize the ability of veterinary medical practitioners to capture patient medical information and owner contact and billing information. In human medicine, an ideal EMR system has efficient search and retrieval capabilities, uses standardized diagnostic coding, and protects patient and client confidentiality while maximizing patient health, quality of care, practice efficiency, and profit.1–4 However, few EVMR models with these capabilities exist in the veterinary medical profession; these include proprietary systems in use by large networks of hospitals,a systems used by veterinary medical teaching hospitals,1 and commercial programs employed by independent clinics and hospitals.b–e It has been suggested that limited market availability of quality, user-friendly EMR and EVMR systems contributes to the finding that, despite well-documented evidence of the benefits that accrue to their use, until 2010, fewer than 50% of physicians used any EMR system,4–7 although the percentage who did increased by 21% between 2012 and 2013, presumably in response to the Health Information Technology for Economic and Clinical Health Act of 2009.8 By contrast, most veterinarians do not use electronic records.4,9–10 Researchers have found a significant relationship between perceived benefits and barriers to EMR adoption and hospital size.5,11 The result in the human medical profession is an increasing digital divide between hospitals and physician offices that have adopted EMR systems and those that have not.12 The American Hospital Association researchers identified cost as a major barrier to EMR adoption by smaller hospitals, with larger hospitals making use of more health information technology than smaller ones.4,11 Survey data and qualitative research about the benefits of and barriers to adopting EVMR systems have been limited. A review of the literature and anecdotal reports suggests that veterinary medical professionals may face the same barriers as their human medical counterparts in this regard.13 In addition to financial barriers (including inadequate capital),4,5,11 other barriers to adoption highlighted by human medical informatics research include inadequate technical capabilities, lack of health information data standards, gaps in system interoperability, clinician reluctance to change, perceived loss of productivity, interruptions in access to the Internet, and lack of interest in existing products.4,14,15 Nevertheless, results of a 1997 telephone survey of animal hospitals demonstrated an interest among veterinary professionals in adoption and use of medical records database software to improve patient care.9 The desire for a simple, complete EVMR was highlighted in a commentary that lauded electronic systems for their potential to improve quality of patient care and reduce medical errors.16 In the United States, it has been estimated that 44,000 human deaths/y result from clinical errors in the medical profession, imposing a $17 billion burden on the healthcare system and society.2 Electronic medical records improve communication among members of medical teams, which facilitates the implementation of care guidelines and decision-support tools to improve patient safety and reduce medical errors through 8 core functionalities defined by the Institute of Medicine. These functionalities are health information and data, results management, order management, decision support, electronic communication and connectivity, patient support, administrative processes, and reporting and population health.17 Electronic veterinary medical record systems available to the veterinary medical profession are believed to include some of these capabilities, although they have not been described as specifically having or lacking these functions.1,10,13,14 Receiving greater attention recently, however, is the potential of EVMRs to contribute to understanding the epidemiology of animal diseases, including those that have zoonotic potential.18 A comprehensive literature review in 2001 found that 868 of 1,415 (61%) infectious human pathogens were zoonotic and 132 of 175 (75%) pathogenic species associated with EIDs were zoonotic.19 An updated literature review and a review of EID events between 1940 and 2004 reached similar conclusions.20,21 Data such as these create additional incentive to establish and use EVMRs, and interest in an animal health database for animal disease surveillance and public health is increasing.18 A 2006 report22 described the use of electronic health records maintained by a large network of primary care veterinary hospitals for surveillance of clinical syndrome and disease patterns as well as emerging and zoonotic diseases among companion animals in the United States. The EVMR system used in that study22 remains proprietary, however, and the extent to which patient health records from independent small animal veterinary medical clinics are being used for similar purposes is unknown. To our knowledge, no recent study has addressed the factors that influence EVMR adoption by veterinarians, compared veterinary medical record systems with those used in human medical practices or facilities, or provided empirical data on EVMR functionality, usability, or costs and benefits.13 The purpose of the study reported here was to estimate the proportion of independent small animal veterinary medical practices in Massachusetts that use EVMRs, determine the purposes for which these EVMR systems are used, and identify barriers to EVMR adoption. We also sought to identify practitioners’ degree of satisfaction and reasons for dissatisfaction with EVMR systems where these were in use. Our hypotheses were that size of veterinary medical practice was not related to use of an EVMR and that there was no difference in EVMR functions used in practices that had EVMRs only, compared with those that used EVMRs in combination with paper records.