Survey: Digital Divide Between Patients, Physicians Continues

Alicia Ault

September 28, 2016

A digital divide of sorts still exists between physicians and patients in how they view the use of technology such as electronic health records (EHRs), patient portals, and smartphone apps for self-diagnosis.

That's according to a recent Medscape survey of 1423 health professionals (including 847 physicians) and 1103 patients. The biggest gap was seen with EHRs. Eighty percent of patients said EHRs make a practice more efficient, compared to just 54% of physicians. Just over 90% of doctors said they used EHRs, but 1 of every 2 said it reduced their efficiency.

Web portals were also viewed favorably by patients, with two thirds saying they improved the relationship with the doctor. More than half of patients said a portal was available for accessing their physician, and about a fifth said they always or almost always made use of the communication method.

But only 49% of physicians agreed that it improved relations, perhaps because just over half said they rarely used the technology to communicate with patients — even though most had a portal. Physicians younger than 34 were substantially more likely than older colleagues to use the portal.

Despite the patients' thumbs-up in the survey, Web portals have not been shown to improve health outcomes or even patient satisfaction. But a 2012 systematic review of controlled trials looking at the portals found that they helped decrease office visits.

Unease With Technology

The survey showed that patients had a relatively open mind when it came to how technology can be used to deliver medical care, with telemedicine and smartphone apps being seen as appropriate ways to consult, conduct a lab test, or get a diagnosis.

Some 3 in 5 physicians, however, viewed technology as something that was a requirement, not as something offering new potential. Doctors younger than 35 viewed technology as exciting, while those over 55 were perplexed.

Overall, though, physicians said they were comfortable with the idea of an app being used to conduct certain diagnostics — like blood glucose testing ― but they were less enthusiastic about technologies that purport to diagnose.

About 18% of physicians said patients should be able to use technology to self-diagnose, whereas 31% said they were uneasy about it and that they'd prefer to see patients in person to make a diagnosis.

When compared to a similar survey Medscape conducted in 2014, patients have grown more comfortable with technology. Physicians have increased their acceptance as well, but still have a big measure of wariness — even as technology has substantially changed in the past 2 years, with ever more routine diagnostics being made available by smartphone.

Most patients and physicians have had no experience with telemedicine, but a little more than half of each survey group thought video or phone consults were acceptable for routine medical issues or follow-up for chronic conditions. But physicians drew the line when it came to using email or video to write prescriptions. Thirty-two percent of doctors said they disagreed or strongly disagreed with writing prescriptions after an email or video visit, while almost two thirds of patients said it was just fine.

Physicians overestimated the importance that patients place on in-office visits, with 81% saying they believed patients prefer to be seen in the office. Just 68% of patients indicated that preference.

Who Owns Records?

Physicians and patients also disagreed — strongly ― over who owns the medical record and how much of the doctor's notes a patient should be able to access.

Sixty percent of patients said they own their medical record — a view shared by just 38% of physicians. An almost equal number of doctors (37%) said they owned the record. But a quarter of physicians and 19% of patients said they didn't know who had ownership — reflecting confusion over the issue. State laws set ownership, and the variation is tremendous.

Almost 90% of patients said they had a right to see all of the physician's notes, compared with just 60% of doctors. Older physicians tended to believe a patient should have full access, whereas the 25- to 34-year-old doctors were more likely to want to protect their notes.

Physicians were also more protective of lab results, with the majority saying they should read all results before sharing them with patients. Forty-one percent of patients, however, thought they should get results immediately, without any interpretation first.

Most patients also said they wanted a bigger role in decision making. Only 10% said the physician should be the sole director of their care, while 70% said they wanted to be presented options by the doctor and then make their own decision. About a fifth said they preferred to do their own research and then reach a decision jointly with a physician.

The survey had a margin of error of ±2.95% for patients and ±2.6% for all healthcare professionals, which included physicians, nurses, physician assistants, nurse practitioners, and medical students.

The physicians surveyed primarily were male and employed. Almost a third were in a solo or group practice, and about a quarter worked in a hospital. They ranged in age — about a fifth fell into each age group: 18 to 34, 35 to 44, 45 to 54, and 55 to 64. Just under half had an urban practice, and 44% had a suburban practice. The vast majority of patients — 81% ― were older than 55; they had at least two chronic health conditions and had made an average of two physician visits in the preceding 3 months. Fifty-six percent lived in a suburban area, and 62% were women.


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