Accenture Doctors Survey - All Country Profiles

Health Insight Driven Health
Doctors Survey: Country Profiles & Charts
Table of Contents
Overview Country Profiles Australia Canada Germany Singapore England France Spain United States Appendix Charts: The Digital Doctor is In Charts: Todays Digital Doctor: Online, But Not In Touch
Copyright 2012 Accenture All rights reserved.
Overview
Accenture conducted an online survey of 3,700 doctors across eight countries: Australia, Canada, England, France, Germany, Singapore, Spain and the United States.
Approximately 500 doctors per country (200 for Singapore) participated in the survey, which assessed doctors attitudes and perceptions on the benefits of health information and communications technology. The survey was conducted between November 16, 2012 and December 27, 2012. Accordingly, it took place in the months immediately following the launch of Australias national eHealth record service, the PCEHR system. The analysis provided comparisons by country, sector, age and use. The margin of error for the eight study countries in total is +/- 1.5% and the margin of error for Australia is +/- 4%.
Method: Data Collection Summary
Australia
Canada
England
France
Germany
Singapore
Spain
US
Number of Completed Interviews (3700 total)* Field Start Date

Field End Date Average Interview Length (in minutes) Language
500
500
500
500
500
200
500
500
Nov. 20 Nov. 19 Nov. 19 Nov. 16 Nov. 16

Dec. 15 Dec. 16 Dec. 17 Dec. 23 Dec. 15 16 English 14 15 15 14
Nov. 19
Dec. 27 15 English
Nov. 16 Nov. 16
Dec. 17 Dec. 17 15 14
English English French German French
Spanish English
*In each country half the completed interviews were among primary care physicians and half were among specialists. **First amount is for primary care physicians, second amount is for specialists.
Method
With whom did Accenture work to conduct the quantitative survey? Accenture worked with Harris Interactive, who was responsible for the entire project including recruitment and screening of physicians from M3 Global Research online panel of more than 1.3 million verified, worldwide healthcare professionals. What kinds of doctors/physicians were surveyed? Primary and secondary/specialist care doctors in Australia, Canada, England, France, Germany, Singapore, Spain, and the US who have registered to take part in market research. All work on a full time basis, in a mix of private and public practice settings. Most spend almost 80% of their working time in direct patient care and have been practicing medicine for almost 18 years (on average). How did Accenture recruit physicians for the study? Physicians were contacted through a web mail out, whereby they were able to follow a unique link to the survey and complete it anonymously. To maximize participation up to two email reminders were sent. Are we confident in the quality of the respondents and that they meet the study criteria? All physicians details are double verified when they join the panel and were rescreened for this study to ensure participant quality. Was the questionnaire translated into the appropriate native language? Yes, the survey was translated into: French (France); German (Germany), and Spanish (Spain). The English was localized for Australia, England and Singapore.
Terminology
Healthcare IT is an umbrella term for the exchange of health information in an electronic environment, including health information exchange, electronic medical record and electronic health record. Health information exchange (HIE) is the mobilization of healthcare information electronically across organizations within a region, community or hospital system.
An electronic medical record (EMR) is a computerized medical record created in an organization that delivers care, such as a hospital or doctor's office, usually part of a local standalone health information system that allows storage, retrieval and modification of records.
Doctors Survey: Australia Country Profile
Research Results
Highlights of Australia and 8-Country Findings
Key Australia Findings - Summary
Key study findings for Australian physicians revealed that over the last two years, doctors use of healthcare IT and HIE has largely remained constant. Australian doctors reported a significant increase in electronic access to clinical patient data provided by a different health organization. Australian respondents indicated that they have realized important HIE benefits such as improved decision-making and the reduction of medical errors. However, it appears expectations have declined in terms of anticipated economic benefits, such as reducing organizational costs. The use of the internet by Australian doctors remains limited. They are among the least likely to view videos online, comment on online articles, access news from an RSS feed, and follow a colleague or medical professional through social media. Moreover, doctors across all eight countries uniformly agree on two key issues: 1) Cost is the main barrier to electronic medical record (EMR) adoption, and 2) Patients should have at least some access to and be able to update elements of their EMR.
Australia Physician Demographics

8-Country Total
(n=3,700) Gender Male Female Age 73% 27% 68% 32%
AUS
(n=500)
8-Country Total (n=3,700)
AUS (n=500)
Organization Status
Public Private not-for-profit/charitable Private for profit 2% 0% Average # of Physicians in Organization Primary Work Setting Mostly office - or clinic-based Exclusively hospital - or lab-based Mostly hospital - or lab-based Equally hospital-based and office/clinic-based 50% 50% 18.3 79% 50% 50% 22.0 80% Mostly long-term care facility-based Mostly hospice-based Other Practice Size (among those who work in office/clinic) Solo practice 66% 20% 14% 57% 35% 8% Single-specialty partnership or group (2 or more physicians) Multi-specialty partnership or group (2 or more physicians) 62% 15% 13% 8% 1% 1% 1% (n=2604) 71% 10% 11% 7% 0% 0% 1% (n=389) 54% 7% 39% 172.1 28% 3% 68% 116.1
Under 30
30-39 40-49 50-59 60+ Physician Type Primary Care/General Practice/Family Physician Secondary Care/Specialist Average # of Years Practicing Medicine Average Time Spent Face-to-Face with Patients
24%
34% 30% 10%
21%
35% 30% 14%
Location of Primary Work Place

Urban/City Suburban/Next to a city Small town/Rural
Note: Unweighted Data Base: All Qualified Respondents
28%
44% 28%
19%
58% 24%
10
Doctors in Australia and abroad experienced a large significant increase in ability to electronically access clinical data about a patient seen by a different health organization. However, declines were also reported by Australian doctors in some areas e.g. electronically sending order requests and communicating electronically with clinicians in other organizations.
8-Country Total Healthcare IT I electronically enter patient notes either during or after consultations My organization uses electronic tools to reduce the administrative burden for delivering health care (e.g., e-scheduling or e-billing) I receive electronic alerts/reminders while I am seeing my patients (e.g., prompts regarding contraindications or preventative care) I use computerized clinical decision support systems to help make diagnostic and treatment decisions while I am seeing my patients (e.g., real-time access to evidence-based practice guidelines) HIE I have electronic access to clinical data about a patient who has been seen by a different health organization (e.g., hospital, laboratory) I am electronically notified of my patients interactions with other health organizations (e.g., admissions to hospital) I electronically send prescriptions to pharmacies (e-Prescribing) I electronically send order requests (e.g., for lab, radiology or diagnostic tests) to laboratories 33% 18% 18% 36% 25% 30%* 47%* 20%* 21% 34% 27%* 22% 42% 11% 17% -6% 8% -27% 26% 15% 5% 22%* 16% 25%* 62% 42%* 20%* 6% 12% 15% 13% 67% 62% 33% 20% -45% -6% -48% 8% 2011 58% 54%* 31% 2012 66%* 47% 36%* % change 14% -13% 16% 2011 56% 57%* 40% Australia Total 2012 64%* 50% 44% % change 14% -12% 10%
20%
22%*
10%
17%
15%
-12%
I electronically send or receive referrals to/from health professionals in other organizations (e.g., for specialist appointments)
I communicate electronically with clinicians in other organizations (e.g., via secure email) I receive clinical results electronically that populate my patients electronic medical record *Significant difference between 2011 and 2012; p<.05
53%
54%
2%
11
Australia reported virtually no change in adoption of Healthcare IT and HIE from 2011 to 2012.
Connected Health Maturity Index: Total Doctors, 2011-2012
Y Axis
60
2011
2012
Australia 2011
Australia 2012
50
Spain Spain US
Health information exchange (% routine users)
40
England England
Singapore US
Singapore
30
Canada
20
France Australia Germany Germany Australia France
Canada
10 10 20 30 40 50 60
X Axis EMR adoption and use (% routine users)
Note: Unweighted Data Base: All Qualified Respondents Q705. How frequently do you use/perform the following functions/activities?
12
Routine use of HIE is on the rise in Australia (consistent with the trend in other countries). At the same time, the perception that HIE reduces costs has fallen. In 2012 doctors were less likely to report that HIE reduces costs to their organization or service compared to 2011.
HIE Use and Physician Perceived Cost Reduction

60% 52% 50% 40% 30% 20% 10% 0% 2011 2012 48% 41% 33% Reduces Organizational Cost (8 country total) Routine HIE Users* (8 country total)
21% 19%
Routine HIE Users* (Australia)
12%
13%
Reduces organizational Cost (Australia)
*Reduced Base: Excludes doctors not interested in using Healthcare IT or HIE.
13
Although doctors in Australia report many benefits of HIE, such as improved decision-making ability and reduced medical errors, it appears expectations in terms of economic benefits have declined since 2011. Fewer doctors in 2012 reported reduced service costs, reduced patient wait times, increased numbers of patients that can be seen per day, and reduced risk of litigation.
8-Country Total 2011 Improved diagnostic decisions Improved quality of treatment decisions Reduction in medical errors Reduced costs for my own organization/service Reduced waiting lists/waiting times Increased numbers of patients that can be seen per day Reduced risk of litigation Improved work-life balance 68% 69% 73% 60% 48%* 46%* 57%* 47%* 2012 74%* 74% 76% 47% 38% 34% 44% 34% % Change 9% 7% 4% -22% -21% -26% -23% -28% 2011 63%
Australia 2012 71%* % Change 13%
65%
74% 58%*
70%
77% 38%
8%
4% -34%
39%* 44%*
63%* 47%*
27% 30%
46% 35%
-31% -32%
-27% -26%
*Significant difference between 2011 and 2012; p<.05
14
For the second year, doctors reported that the main barrier to electronic medical records (EMR) and HIE adoption is cost to my organization. In Australia, doctors ranked lack of technical expertise to manage the EMR implementation and difficulty in using EMR systems as growing concerns.
Barriers to EMR/HIE Adoption

8-Country Total 2011 Ranked 1st Most Important Cost to my organization Concerns about privacy and security of patient data Concern about loss of productivity/too time consuming to input data The system is too difficult to use IT systems that can't 'talk' to each other Lack of technical expertise to manage implementation Lack of easy access to a computer Low IT literacy/lack of training among clinicians and staff 14% 13% 10% 5% 11% 4% 2% 5% 2011 2012 Ranked 1st Most Important 24% 11% 10% 8% 8% 6% 5% 5% 2012 2011 Ranked 1st Most Important 15% 12% 9% 4% 10% 7% 1% 7% Australia Total 2011 2012 Ranked 1st Most Important 19% 12% 9% 6% 8% 11% 2% 8% 2012
Rank
Rank
Rank
Rank
1 2 4 6 3 7 9 6
1 2 3 4 4 5 6 6
1 2 4 7 3 5 10 5
1 2 4 6 5 3 10 5
More important (moved up in rank) in 2012. Less important (moved down in rank) in 2012.
Copyright 2013 Accenture All rights reserved. 15
Many doctors in Australia indicate support for patients being able to update certain information in their electronic medical record such as demographic information and family medical history. However, the level of support for such updates is lower than most of the other countries and opposition particularly pronounced in certain areas e.g. patients updating lab test results. Patient Allowed Access to Electronic Medical Record
8-Country Total
8-Country Total No Access 14% Full Access 24% Lab test results Change in symptoms New symptoms New medications 45% 23% 23% 21% 20% 19% 18% 17% 15% 34% 32% 28% 33% 33% 37% 28% 29% 25% 29% 44% 46% 50% 47% 48% 45% 55% 55% 65% Australia Total 59% 28% 27% 29% 28% 28% 25% 26% 22% 33% 34% 29% 38% 32% 39% 27% 29% 17% 24% 39% 39% 42% 33% 40% 36% 48% 49%
Patient Updateable Information in Electronic Medical Record
Limited Access 62%
Personal medical history

Medication side effects
Australia Total
Self-measured metrics No access 16% Full access 18%
Allergic episodes
Family medical history
Limited access 65%
Demographic information 11% 24%
13% 24%
Some information
63%
All information
Patient should not update
16
Research Results
Highlights of Comparative Country Findings
Globally, as well as in Australia, most physicians use EMR in either their own practice OR hospital/ clinic. (91% and 83%, respectively). Location of EMR Use
Use in my own practice

Yes (NET): 95% 93% 93% 92% 91%
Use in my hospital or clinic

87% 83% 82% 76%
73%
68% 59% 39% 27%
65%
63%
67% 60% 46% 34% 27% 37% 37% 58% 51% 43% 47%
Spain
Germany
US
France
Global Total
Singapore
Australia
England
Canada
(n=500)
(n=500)
(n=500)
(n=500)
(n=3,700)
(n=200)
(n=500)
(n=500)
(n=500)
Note: Weighted Data Base: AUS, CAN, FRANCE, GERMANY, SINGAPORE, SPAIN, England Or US And Currently Practicing Medicine Q615. Do you use electronic patient medical records in your practice (excluding billing systems)?
18
Globally, the number of physicians electronically entering patient notes routinely has increased since last year (up 14%). Routine use in Australia also increased by 14%. I electronically enter patient notes either during or after consultations
% Use Routinely Change from 34% 2011-2012
4%
1%
1%
14%
14%
19%
27%
22%
Use Routinely
41% 58% 58% 56% 66% 64% 54% 64% 7% 6% 19% 6% 4% 8% 6% 7% 5% 11% 5% 3% 4% 11% 9% 3% 9% 5% 5% 9% 4% 9% 8% 9% 7% 7% 10% 4% 5% 13% 9% 9% 5% 10% 19% 5% 12% 10% 8% 4% 9% 26% 5% 17% 16% 8% 5% 7% 2011 2012 2011 2012 18% 7% 15% 15% 12% 2011 2012 6% 19% 36% 29% 8% 7% 52% 67% 68% 36% 44%
Use Sometimes
78%
74% 77%
72% 73%
Use Rarely
6% 10%
18% 7% 12% 10% 7% 2011 2012
Interested in Using
Not Interested in Using
23%
7% 2% 9% 4%
9%
2011 2012
2011 2012
2011 2012
2011 2012
2011 2012
US
Germany
Spain
France
Global Total
Australia
England
Singapore
Canada
(n=500)
(n=500)
(n=500)
(n=500)
(n=3,700)
(n=500)
(n=500)
(n=200)
(n=500)
19
Globally, the number of physicians who routinely access clinical data about patients seen by different health organizations has increased by 42%. Australia increased its routine use by 62%. I have electronic access to clinical data about a patient who has been seen by a different health organization (e.g., hospital, laboratory)
% Use Routinely Change 41% from 2011-2012
32%
53%
42%
32%
42%
62%
77%
17%
32% 41% 49% 69% 19% 17% 15% 5% 15% 6% 13% 24% 5% 10% 6% 3% 8% 3% 2011 2012 2011 2012 6% 29% 22% 24% 22% 5% 2011 2012 17% 7% 10% 15% 54% 49%
33% 47%
34% 45%
31% 44%
26% 42%
22% 39% 12%
Use Routinely
29% 34%
Use Sometimes
13% 10% 14% 7% 5%
15% 15% 7% 15% 18% 7% 15% 6% 34% 24% 35% 5% 19% 17% 6% 8% 38% 26% 43% 28% 15% 16% 2011 2012 6% 17% 6% 43% 28% 8%
Use Rarely
7%
37% 37%
Interested in Using Not Interested in Using
24%
11% 8% 2011 2012 8% 9% 7% 10% 7% 2011 2012 14% 10%
4%
2011 2012
2011 2012
2011 2012
Spain
England
Singapore
Global Total
US
Canada
Australia
Germany
France
(n=500)
(n=500)
(n=200)
(n=3,700)
(n=500)
(n=500)
(n=500)
(n=500)
(n=500)
20
Globally, the number of physicians who routinely e-Prescribe increased by 17% since 2011. Australia increased routine e-Prescribing usage from 5% to 6%. Australia and Germany have the lowest proportions of physicians routinely e-Prescribing among study countries. I electronically send prescriptions to pharmacies (e-Prescribing)
36%
32%
17%
0%
0%
-36%
20%
5% 5% 9% 6% 5% 7%
-43%
4% 5% 8%
25% 36% 49% 65% 17% 13% 7% 11% 21% 5% 12% 10% 7% 2011 2012 8% 16% 43% 14% 8% 39% 49% 6% 10% 6% 33%
18% 21%
8% 10%
12% 12% 8% 9%
8% 6%
8% 5%
11%
10%
7% 9% 11%
7% 5% 11%
Use Routinely
9% 10%
8% 8%
11% 7%
12%
Use Sometimes
47%
7%
52% 55% 57% 59% 43% 57% 58%
44%
Use Rarely
43% 43%
42%
Interested in Using
25%
30% 33% 36% 24% 24%
20%
25%
16% 15% 7% 2011 2012 2011 2012
21% 20%
17% 17%
20% 18%
2011 2012
2011 2012
2011 2012
2011 2012
2011 2012
2011 2012
US
Singapore
Spain
Global Total
England
Canada
France
Australia
Germany
(n=500)
(n=200)
(n=500)
(n=3,700)
(n=500)
(n=500)
(n=500)
(n=500)
(n=500)
21
Globally, there is a 16% increase in the number of physicians reporting they routinely receive electronic alerts/reminders while seeing patients; in Australia there is a 10% increase. I receive electronic alerts/reminders while I am seeing my patients (e.g., prompts regarding contraindications or preventative care)
32%
10%
3%
16%
13%
52%
-4%
12%
21% 34% 45% 46% 45% 40% 44% 37% 38% 31% 36% 31% 35% 15% 32%
27% 26%
17% 19% 7% 11%
Use Routinely
13% 13% 14% 9% 13% 11% 5% 8% 31% 29% 24% 22% 14% 15% 27% 22% 31% 23% 14% 13% 2011 2012 19% 11% 2011 2012 6% 16% 13% 7% 8% 16% 20% 13% 15% 9% 9% 11% 33% 27% 20% 20% 17% 16% 20% 10% 14% 33% 27% 20% 20% 14% 20% 9% 11%
11% 8%
Use Sometimes
Use Rarely
47% 45%
7%
9%
9% 35% 30%
Interested in Using
10%
9%
13% 13% 2011 2012
7%
8%
12%
18% 17%
2011 2012
2011 2012
2011 2012
2011 2012
2011 2012
2011 2012
England
US
Australia
Spain
Global Total
Singapore
Germany
France
Canada
(n=500)
(n=500)
(n=500)
(n=500)
(n=3,700)
(n=200)
(n=500)
(n=500)
(n=500)
22
Globally as well as in Australia, the majority of physicians believe that patients should have at least limited access to their electronic personal health records (85% and 83%, respectively). Access Patient Should Have to Electronic Personal Health Record
34%
31%
30%
29%
24%
22%
21%
18%
12% Full access
54% 65% 65% Limited access
60%
65%
63%
57%
61%
68%
34% 6% England 4% US 7% Singapore
No access
14%
Canada
14%
Global Total
13% Spain
11%
France
16% Australia Germany
(n=500)
(n=500)
(n=200)
(n=500)
(n=3,700)
(n=500)
(n=500)
(n=500)
(n=500)
Note: Weighted Data Base: All Qualified Respondents Q710. What level of access should a patient have to his or her electronic personal health record?
23
Australian doctors opinions about the extent to which patients should be able to update demographic information is in line with the 8-country total (87% and 89%, respectively). Demographic Information
All/Some Information (Net)
95% 90% 89% 88% 88% 87% 86% 86% 80%
41% 55% 79% 73% 65% 62% 63% 60%
57%
All information
Some information
39% 33% 18% 16% 5% US 10% Canada 11% 12% 12% England 13% Australia 14% France 14% Spain 24% 25% 24% 26% 29%

20%
Global Total Singapore
Germany
(n=476)
(n=430)
(n=3,200)
(n=184)
(n=473)
(n=429)
(n=444)
(n=439)
(n=325)
Note: Weighted Data Base: All Qualified Respondents Q712. How much information should a patient be able to update in his or her electronic personal health record?
24
Approximately half of physicians, both globally (55%) and in Australia (49%), are in favor of allowing patients to update all information about their family medical history in their health record. Family Medical History
91%
91%
88%
85%
84%
84%
81%
78%
72%
37%
54% 65% 67% 55% 54% 47% 49%
43%
All information
Some information
44% 37% 29% 29% 37%
29%
21%
31%
26%

22% 28%
9% France
9% Singapore
12% US
15%
Global Total
16% Canada
16% England
19%
Germany
Australia
Spain
(n=444)
(n=184)
(n=476)
(n=3,200)
(n=430)
(n=473)
(n=325)
(n=429)
(n=439)
25
Approximately half of physicians, both globally (55%) and in Australia (48%), feel that patients should be able to update all information about allergic episodes in their health record. Allergic Episodes
90%
85%
83%
83%
81%
80%
79%
77%
74%
44%
57%
70%
55%
62%
54%
49%
52%
48%
All information Some information
37% 28% 20% 10% France 15% US 17% Global Total 17% Spain 19% 20% 28% 26% 20%
30%
25%
27% Patient should not update 26%
21%
23%
Germany
Singapore
Canada
England
Australia
(n=444)
(n=476)
(n=3,200)
(n=439)
(n=325)
(n=184)
(n=430)
(n=473)
(n=429)
26
Globally, slightly more than three-quarters of physicians are in favor of allowing patients to update at least some information about changes in symptoms in their health record. The level of support in Australia is slightly lower: seven out of ten doctors feel that patients should be able to update at least some of this information. Change in Symptoms
86%
81%
81%
77%
75%
72%
72%
71%
71%
33% 43% 47% 50% 44%
39%
40%
36% 45% All information
42% 43% 34%
33%
32%
35% 26%
Some information Patient should not update
34%
31%
14% Singapore
19%
19%
23%
25%
28%
28%
29%
29%
France
US
Global Total
Germany
Australia
England
Canada
Spain
(n=184)
(n=444)
(n=476)
(n=3,200)
(n=325)
(n=429)
(n=473)
(n=430)
(n=439)
27
Globally, eight out of ten physicians are in favor of allowing patients to update at least some information about medication side effects in their health record. Australian physicians are least in favor of patients entering this type of information with 28% opposed. Medication Side Effects
84%
82%
82%
81%
80%
79%
78%
78%
72%
53%
47%
50%
48%
53%
48%
41%
39%
40% All information
31%
35%
32%
33%
27%
31%
37%
39%
32%
16% France
18% Singapore
18% US
19%
20%
21%
22%
22%
28%
Global Total
Spain
England
Canada
Germany
Australia
(n=444)
(n=184)
(n=476)
(n=3,200)
(n=439)
(n=473)
(n=430)
(n=325)
(n=429)
28
Globally, eight out of ten physicians are in favor of allowing patients to update at least some selfmeasured metrics information in their health record. Australian doctors are least likely to be in favor of this with 25% opposed. Self-Measured Metrics
93%
88%
83%
82%
81%
79%
78%
77%
75%
44% 54% 53%
45%
45%
48%
41%
43%
36% All information Some information
39% 39% 35%
37%
36%
32%
37%
39% 35% Patient should not update
7% Singapore
12% France
17% Germany
18% Global Total
19%
21%
22%
23%
25%
US
Spain
England
Canada
Australia
(n=184)
(n=444)
(n=325)
(n=3,200)
(n=476)
(n=439)
(n=473)
(n=430)
(n=429)
29
The majority of physicians feel that the quality of patient care throughout the healthcare system has improved due to the use of EMR (61%). Australian physicians opinions correspond with the 8country total (58%). Change in Quality of Patient Care
It has improved
65%
87% 84%
63%
63%
61%
58%
56%
53%
It has stayed about the same
28% 27% 10% 2%

Singapore
It has gotten worse
31%
33%
30%
36%
40% 19%
9% 7%
Spain
7%
England
6%
Canada
4%
France
10%
Global Total
6%
Australia
4%
Germany US
(n=200)
(n=500)
(n=500)
(n=500)
(n=500)
(n=3,700)
(n=500)
(n=500)
(n=500)
Note: Weighted Data Base: All Qualified Respondents Q700. Compared to three years ago, how has the quality of patient care throughout the healthcare system changed because of the use of electronic medical records (EMR) (...)?
30
Globally and in Australia, seven out of ten physicians have read online forums in the past six months. Physicians in Australia and Germany are least likely to have accessed news from an RSS feed. Internet Usage in the Past Six Months
Global Total
(n=3,700)
Australia
(n=500)
Canada
(n=500)
England
(n=500)
France
(n=500)
Germany
(n=500)
Singapore
(n=200)
Spain
(n=500)
US
(n=500)
Read online forums
71%
70%
76%
77%
51%
61%
74%
66%
82%
Viewed an online video Commented and/or posted to an online article or forum Accessed news from an RSS feed 'Followed' a colleague or medical professional through Twitter or other social media platform I do not use the Internet for these activities.
52%
48%
53%
58%
52%
45%
50%
49%
57%
29%
17%
17%
28%
17%
45%
35%
33%
24%
19%
12%
15%
18%
25%
12%
29%
35%
17%
12%
5%
8%
15%
7%
10%
28%
24%
10%
12%
19%
13%
10%
19%
14%
11%
12%
9%
Note: Weighted Data Base: All Qualified Respondents Q737. In the past six months, in what ways have you used the Internet to seek or exchange relevant health practices or industry information?
31
Doctors Survey: Canada Country Profile
Research Results
Highlights of Canada and 8-Country Findings
Key Canada Findings - Summary
Key study findings for Canadian physicians revealed that over the last two years, their use of healthcare IT and HIE has risen. However they report the lowest overall use of EMR compared to the other seven countries studied.
Canadian doctors are starting to make use of these technologies, despite the fact that many agree that the use of HIE, specifically, does not reduce organisational cost as anticipated. Canadian physicians are also using the Internet less than physicians globally. Physicians in Canada are less apt to comment on an online article, access news from an RSS feed, or follow a medical professional through social media, compared to physicians in the seven other countries. Nevertheless, Canadian doctors state that they have gained important HIE benefits such as improved decision-making and the reduction of medical errors. Canadian physicians have a stronger intention to use these technologies than their global counterparts, but this does not translate into actual adoption of HIE and EMR
Moreover, doctors across all eight countries uniformly agree on two key issues:

1) Cost is the main barrier to electronic medical record (EMR) adoption, and 2) Patients should have at least some access to and be able to update elements of their EMR.
34
Canada Physician Demographics

8-Country Canada Total
(n = 3700) Gender Male Female Age Under 30 30-39 40-49 50-59 60+ Physician Type Primary Care/General Practice/Family Physician Secondary Care/Specialist Average # of Years Practising Medicine Average Time Spent Face-to-Face with Patients Location of Primary Work Place Urban/City Suburban/Next to a city Small town/Rural
8-Country Canada Total

(n = 3700) Organisation Status (n = 500)
(n = 500)
73% 27%
71% 29%
Public Private not-for-profit/charitable Private for profit
54% 7% 39% 172.1
70% 2% 25% 109.6
2% 24% 34% 30% 10%
0% 19% 36% 31% 14%
Average # of Physicians in Organisation Primary Work Setting Mostly surgery- or clinic-based
62% 15% 13% 8% 1% 1% 1%
63% 14% 9% 12% 1% 1% 1% (n = 325) 30% 45% 26%
Exclusively hospital- or lab-based

Mostly hospital- or lab-based Equally hospital-based and surgery/clinic-based
50% 50% 18.3 79%
50% 50% 18.9 83%
Mostly long-term care facility-based Mostly hospice-based Other
Practice Size (among those who work in surgery/clinic) (n = 2604) Solo practice 28% 44% 28%
66% 20% 14%
76% 13% 11%
Single-speciality partnership or group (2 or more physicians) Multi-speciality partnership or group (2 or more physicians)
35
Doctors in Canada, as well as globally, increasingly use healthcare IT functions such as patient information record-keeping. Canadian doctors have also seen an increase since 2011 in electronically accessing clinical data about patients seen by different health organisations, which is consistent with global findings.
8-Country Total Healthcare IT I enter patient notes electronically either during or after consultations My organisation uses electronic tools to reduce the administrative burden for delivering health care (e.g., e-scheduling or e-billing) I receive electronic alerts/reminders while I am seeing my patients (e.g., prompts regarding contraindications or preventative care) I use computerised clinical decision support systems to help make diagnostic and treatment decisions while I am seeing my patients (e.g., real-time access to evidence-based practice guidelines) HIE I have electronic access to clinical data about a patient who has been seen by a different health organisation (e.g., hospital, laboratory) I am notified electronically of my patients interactions with other health organisations (e.g., admissions to hospital) I send prescriptions to pharmacies electronically (e-Prescribing) I send order requests (e.g., for lab, radiology or diagnostic tests) to laboratories electronically 33% 18% 18% 36% 25% 30%* 47%* 20%* 21% 34% 27%* 22% 42% 11% 17% -6% 8% -27% 31% 13% 8% 18% 16% 20% 36% 44%* 12% 8% 17% 17% 16% 41% 42% -8% 0% -6% 6% -20% 14% 2011 58% 54%* 31% 2012 66%* 47% 36%* % change 14% -13% 16% 2011 36% 50% 17% Canada Total 2012 44%* 50% 19% % change 22% 0% 12%
20%
22%*
10%
15%
18%
20%
I send or receive referrals electronically to/from health professionals in other organisations (e.g., for specialist appointments)
I communicate electronically with clinicians in other organisations (e.g., via secure email) I receive clinical results electronically that populate my patients electronic medical records *Significant difference between 2011 and 2012; p<.05
53%
54%
2%
36
In 2011, doctors in Spain had the highest adoption of Healthcare IT and HIE, whereas doctors in Canada had the lowest. This trend continued in 2012, although Canada did experience an increase in adoption of both Healthcare IT and HIE. Connected Health Maturity Index: Total Doctors, 2011-2012
Y Axis
60
2011
2012
Canada 2011
Canada 2012
50
Spain Spain US
40
England England
Singapore US
Singapore
30
Canada
20
Canada
10 10 20 30 40 50 60
37
In Canada (as well as in the other seven countries), routine use of HIE is on the rise. At the same time, the perception that HIE reduces costs is going down. In 2012 doctors were less likely to report that HIE reduces costs to their organisation or service compared to 2011.

60%
52%
50%
40%
42%
41% 37%
Routine HIE Users* (8 country total)

Reduces Organizational Cost (8 country total)
30% 21% 19%
20%
Routine HIE Users* (Canada) Reduces organizational Cost (Canada)
10%
10% 7%
0% 2011 2012 *Reduced Base: Excludes doctors not interested in using Healthcare IT or HIE.
38
Although doctors in Canada report many benefits of HIE, such as improved decision-making ability and reduced medical errors since 2011, it appears many hoped-for economic benefits have dropped off in the past year. Fewer doctors report reduced service costs, reduced patient waiting times and reduced risk of litigation. Moreover, improvements in the ability to see more patients daily and achieve a better work-life balance have not been realised; in fact, they appear to be declining.
8-Country Total 2011 Improved diagnostic decisions Improved quality of treatment decisions Reduction in medical errors Reduced costs for my own organisation/service Reduced waiting lists/waiting times Increased numbers of patients that can be seen per day Reduced risk of litigation Improved work-life balance 68% 69% 73% 60% 48%* 46%* 57%* 47%* 2012 74%* 74% 76% 47% 38% 34% 44% 34% % Change 9% 7% 4% -22% -21% -26% -23% -28% 2011 63%
Canada 2012 72%* % Change 14%
64%
73% 52%*
72%*
79%* 44%
13%
8% -15%
41%* 42%
53%* 51%*
28% 36%
46% 37%
-32% -14%
-13% -27%
39
For the second year, all doctors indicate the main barrier to EMR and HIE adoption is cost. Although issues regarding privacy and security of patient information have remained a concern to doctors internationally, this is less concerning among Canadian doctors. In 2012, Canadian doctors ranked loss of productivity, difficulty using EMR systems, lack of technical expertise to manage implementation, and lack of staff training to use these systems as growing concerns.

8-Country Total 2011 Ranked 1st Most Important Cost to my organisation Concerns about privacy and security of patient data Concern about loss of productivity/too time consuming to input data The system is too difficult to use IT systems that can't 'talk' to each other Lack of technical expertise to manage implementation Lack of easy access to a computer Low IT literacy/lack of training among clinicians and staff 14% 13% 10% 5% 11% 4% 2% 5% 2011 2012 Ranked 1st Most Important 24% 11% 10% 8% 8% 6% 5% 5% 2012 2011 Ranked 1st Most Important 22% 8% Canada Total 2011 2012 Ranked 1st Most Important 37% 6% 2012
Rank
Rank
Rank
Rank
1 2 4 6 3 7 9 6
1 2 3 4 4 5 6 6
1 5
1 5
10%
6% 12%
3
6 2
10%
7% 8%
2
4 3
4%
1% 4%
7
10 7
7%
1% 5%
4
10 6
Many doctors in Canada state that patients should be able to update information in their EMR such as demographic information and family medical history. Doctors in Canada, as well as those in the other study countries, however, are less enthusiastic about patients updating lab test results. Patient Allowed Access to Electronic Medical Record
8-Country Total
8-Country Total No Access 14% Full Access 24% Lab test results Change in symptoms New symptoms New medications
23%
45% 25% 29%

Canada Total
54% 22% 24%
34%
44%
29%
35%
36%
Limited Access 62%
23%
32%
46%
29%
34%
38%
21%
28%
50%
23%
31%
47%

20%
33%
47%
24%
35%
42%
19%
33%
48%
22%
37%
41%
Canada Total
No access 14%
Self-measured metrics
18%
37%
45%
23%
35%
43%
Allergic episodes
Family medical history Demographic information
17%
28%
55%
21%
30%
49%
15%
29%
55%
16%
31%
54%
11%
24%
65%
10% 18%
73%
Limited access 57%
Full access 29%
Some information
All information
41
Research Results
Globally, as well as in Canada, most physicians use EMR (91% and 76% respectively). Canadian physicians, however, report the lowest overall use of EMR. Location of EMR Use

Yes (NET): 95% 93% 93% 92% 91%

87% 83% 82% 76%
73%
68% 59% 39% 27%
65%
63%
67% 60% 46% 34% 27% 37% 37% 58% 51% 43% 47%
Spain
Germany
US
France
Global Total
Singapore
Australia
England
Canada
(n = 500)
(n = 500)
(n = 500)
(n = 500)
(n = 3700)
(n = 200)
(n = 500)
(n = 500)
(n = 500)
Note: Weighted Data Base: AUS, CAN, FRANCE, GERMANY, SINGAPORE, SPAIN, England Or US And Currently Practising Medicine Q615. Do you use electronic patient medical records in your practice (excluding billing systems)?
43
Globally, the number of physicians entering patient notes electronically and routinely has increased since last year (up 14%). Canada had a large increase in routine use (22%). I enter patient notes electronically either during or after consultations
4%
1%
1%
14%
14%
19%
27%
22%
Use Routinely
41% 58% 58% 56% 66% 64% 54% 64% 7% 6% 19% 6% 4% 8% 6% 7% 5% 11% 5% 3% 4% 11% 9% 3% 9% 5% 5% 9% 4% 9% 8% 9% 7% 7% 10% 4% 5% 13% 9% 9% 5% 10% 19% 5% 12% 10% 8% 4% 9% 26% 5% 17% 16% 8% 5% 7% 2011 2012 2011 2012 18% 7% 15% 15% 12% 2011 2012 6% 19% 36% 29% 8% 7% 52% 67% 68% 36% 44%
Use Sometimes
78%
74% 77%
72% 73%
Use Rarely
6% 10%
18% 7% 12% 10% 7% 2011 2012
Interested in Using
23%
7% 2% 9% 4%
9%
2011 2012
2011 2012
2011 2012
2011 2012
2011 2012
US
Germany
Spain
France
Global Total
Australia
England
Singapore
Canada
(n = 500)
(n = 500)
(n = 500)
(n = 500)
(n = 3700)
(n = 500)
(n = 500)
(n = 200)
(n = 500)
44
Globally, the number of physicians who routinely access clinical data about patients seen by different health organisations has increased by 42%. Canada has also increased its routine use by 42% since 2011. I have electronic access to clinical data about a patient who has been seen by a different health organisation (e.g., hospital, laboratory)
32%
53%
42%
32%
42%
62%
77%
17%
32% 41% 49% 69% 19% 17% 15% 5% 15% 6% 13% 24% 5% 10% 6% 3% 8% 3% 2011 2012 2011 2012 6% 29% 22% 24% 22% 5% 2011 2012 17% 7% 10% 15% 54% 49%
33% 47%
34% 45%
31% 44%
26% 42%
22% 39% 12%
Use Routinely
29% 34%
Use Sometimes
13% 10% 14% 7% 5%
15% 15% 7% 15% 18% 7% 15% 6% 34% 24% 35% 5% 19% 17% 6% 8% 38% 26% 43% 28% 15% 16% 2011 2012 6% 17% 6% 43% 28% 8%
Use Rarely
7%
37% 37%
24%
11% 8% 2011 2012 8% 9% 7% 10% 7% 2011 2012 14% 10%
4%
2011 2012
2011 2012
2011 2012
Spain
England
Singapore
Global Total
US
Canada
Australia
Germany
France
(n = 500)
(n = 500)
(n = 200)
(n = 3700)
(n = 500)
(n = 500)
(n = 500)
(n = 500)
(n = 500)
45
Globally, the number of physicians who routinely e-Prescribe has increased by 17% since 2011. Canada experienced no change in routine e-Prescribing. I send prescriptions to pharmacies electronically (e-Prescribing)
36%
32%
17%
0%
0%
-36%
20%
5% 5% 9% 6% 5% 7%
-43%
4% 5% 8%
25% 36% 49% 65% 17% 13% 7% 11% 21% 5% 12% 10% 7% 2011 2012 8% 16% 43% 14% 8% 39% 49% 6% 10% 6% 33%
18% 21%
8% 10%
12% 12% 8% 9%
8% 6%
8% 5%
11%
10%
7% 9% 11%
7% 5% 11%
Use Routinely
9% 10%
8% 8%
11% 7%
12%
Use Sometimes
47%
7%
52% 55% 57% 59% 43% 57% 58%
44%
Use Rarely
43% 43%
42%
Interested in Using
25%
30% 33% 36% 24% 24%
20%
25%
16% 15% 7% 2011 2012 2011 2012
21% 20%
17% 17%
20% 18%
2011 2012
2011 2012
2011 2012
2011 2012
2011 2012
2011 2012
US
Singapore
Spain
Global Total
England
Canada
France
Australia
Germany
(n = 500)
(n = 200)
(n = 500)
(n = 3700)
(n = 500)
(n = 500)
(n = 500)
(n = 500)
(n = 500)
46
Globally, there is a 16% increase in the number of physicians reporting they routinely receive electronic alerts/reminders while seeing patients; in Canada there is a 12% increase. However, Canadian doctors are least likely to routinely receive electronic alerts while seeing patients. I receive electronic alerts/reminders while I am seeing my patients (e.g. prompts regarding contraindications or preventative care)
32%
10%
3%
16%
13%
52%
-4%
12%
21% 34% 45% 46% 45% 40% 44% 37% 38% 31% 36% 31% 35% 15% 32%
27% 26%
17% 19% 7% 11%
Use Routinely
13% 13% 14% 9% 13% 11% 5% 8% 31% 29% 24% 22% 14% 15% 27% 22% 31% 23% 14% 13% 2011 2012 19% 11% 2011 2012 6% 16% 13% 7% 8% 16% 20% 13% 15% 9% 9% 11% 33% 27% 20% 20% 17% 16% 20% 10% 14% 33% 27% 20% 20% 14% 20% 9% 11%
11% 8%
Use Sometimes
Use Rarely
47% 45%
7%
9%
9% 35% 30%
Interested in Using
10%
9%
13% 13% 2011 2012
7%
8%
12%
18% 17%
2011 2012
2011 2012
2011 2012
2011 2012
2011 2012
2011 2012
England
US
Australia
Spain
Global Total
Singapore
Germany
France
Canada
(n = 500)
(n = 500)
(n = 500)
(n = 500)
(n = 3700)
(n = 200)
(n = 500)
(n = 500)
(n = 500)
47
Globally as well as in Canada, the majority of physicians believe that patients should have at least limited access to their electronic personal health records (85% and 86% respectively). Access Patient Should Have to Electronic Personal Health Record
34%
31%
30%
29%
24%
22%
21%
18%
12% Full access
60%
65%
63%
57%
61%
68%
No access
14%
Canada
14%
Global Total
13% Spain
11%
France
(n = 500)
(n = 500)
(n = 200)
(n = 500)
(n = 3700)
(n = 500)
(n = 500)
(n = 500)
(n = 500)
48
Physicians in Canada (73%) and the US (79%) are most in favour of patients being able to update all demographic information in their personal health record. Demographic Information
95% 90% 89% 88% 88% 87% 86% 86% 80%
41% 55% 79% 73% 65% 62% 63% 60%
57%
All information
Some information

20%
Germany
(n = 476)
(n = 430)
(n = 3200)
(n = 184)
(n = 473)
(n = 429)
(n = 444)
(n = 439)
(n = 325)
49
More than half of physicians, both globally (55%) and in Canada (54%), are in favour of allowing patients to update all information about their family medical history in their health record. Family Medical History
91%
91%
88%
85%
84%
84%
81%
78%
72%
37%
54% 65% 67% 55% 54% 47% 49%
43%
All information
Some information
44% 37% 29% 29% 37%
29%
21%
31%
26%

22% 28%
9% France
9% Singapore
12% US
15%
Global Total
16% Canada
16% England
19%
Germany
Australia
Spain
(n = 444)
(n = 184)
(n = 476)
(n = 3200)
(n = 430)
(n = 473)
(n = 325)
(n = 429)
(n = 439)
50
Approximately half of physicians, both globally (55%) and in Canada (49%), feel that patients should be able to update all information about allergic episodes in their health record. Allergic Episodes
90%
85%
83%
83%
81%
80%
79%
77%
74%
44%
57%
70%
55%
62%
54%
49%
52%
48%
All information
Some information
37% 28% 20% 10% France 15% US 17% Global Total 17% Spain 19% 20% 21% 23% 26% 28% 26% 20% 30% 25% 27%
Germany
Singapore
Canada
England
Australia
(n = 444)
(n = 476)
(n = 3200)
(n = 439)
(n = 325)
(n = 184)
(n = 430)
(n = 473)
(n = 429)
51
Globally, three quarters of physicians (78%) are in favour of allowing patients to update at least some information about changes in symptoms in their health record. In Canada, seven out of ten physicians feel that patients should be able to update at least some of this information. Change in Symptoms
86%
81%
81%
77%
75%
72%
72%
71%
71%
33% 43% 47% 50% 44%
39%
40%
42% 43% 34%
33%
32%
35% 26%
34%
31%
14% Singapore
19%
19%
23%
25%
28%
28%
29%
29%
France
US
Global Total
Germany
Australia
England
Canada
Spain
(n = 184)
(n = 444)
(n = 476)
(n = 3200)
(n = 325)
(n = 429)
(n = 473)
(n = 430)
(n = 439)
52
Both globally and in Canada, around eight out of ten physicians are in favour of allowing patients to update at least some information about medication side effects in their health record. Medication Side Effects
84%
82%
82%
81%
80%
79%
78%
78%
72%
53%
47%
50%
48%
53%
48%
41%
39%
40% All information
31%
35%
32%
33%
27%
31%
37%
39%
32%
16% France
18% Singapore
18% US
19%
20%
21%
22%
22%
28%
Global Total
Spain
England
Canada
Germany
Australia
(n = 444)
(n = 184)
(n = 476)
(n = 3200)
(n = 439)
(n = 473)
(n = 430)
(n = 325)
(n = 429)
53
Both globally and in Canada, around eight out of ten physicians are in favour of allowing patients to update at least some self-measured metrics information in their health record. Self-Measured Metrics
93%
88%
83%
82%
81%
79%
78%
77%
75%
44% 54% 53%
45%
45%
48%
41%
43%
36% All information
39% 39% 35%
37%
36%
32%
37%
39% 35%
7% Singapore
12% France
17% Germany
18% Global Total
19%
21%
22%
23%
25%
US
Spain
England
Canada
Australia
(n = 184)
(n = 444)
(n = 325)
(n = 3200)
(n = 476)
(n = 439)
(n = 473)
(n = 430)
(n = 429)
54
The majority of physicians (61%) feel that the quality of patient care throughout the healthcare system has improved due to the use of EMR, with Canadian physicians feelings in line with the global total (63%). Change in Quality of Patient Care
It has improved
65%
87% 84%
63%
63%
61%
58%
56%
53%
28% 27% 10% 2%

Singapore
It has got worse
31%
33%
30%
36%
40% 19%
9% 7%
Spain
7%
England
6%
Canada
4%
France
10%
Global Total
6%
Australia
4%
Germany US
(n = 200)
(n = 500)
(n = 500)
(n = 500)
(n = 500)
(n = 3700)
(n = 500)
(n = 500)
(n = 500)
55
About three quarters of Canadian physicians have read online forums in the past six months, and about seven out of ten globally. Physicians in Canada are less apt to comment on an online article, access news from an RSS feed, or follow a medical professional through social media, compared to physicians in the seven other countries. Internet Usage in the Past Six Months
Global Total
(n = 3700)
Australia
(n = 500)
Canada
(n = 500)
England
(n = 500)
France
(n = 500)
Germany
(n = 500)
Singapore
(n = 200)
Spain
(n = 500)
US
(n = 500)
Read online forums
71%
70%
76%
77%
51%
61%
74%
66%
82%
Viewed an online video Commented on and/or posted to an online article or forum Accessed news from an RSS feed 'Followed' a colleague or medical professional through Twitter or other social media platform I do not use the Internet for these activities
52%
48%
53%
58%
52%
45%
50%
49%
57%
29%
17%
17%
28%
17%
45%
35%
33%
24%
19%
12%
15%
18%
25%
12%
29%
35%
17%
12%
5%
8%
15%
7%
10%
28%
24%
10%
12%
19%
13%
10%
19%
14%
11%
12%
9%
56
Doctors Survey: Germany Country Profile
Research Results
Highlights of Germany and 8-Country Findings
Key Germany Findings - Summary
Key study findings for German physicians revealed that over the last two years, use of HIE is declining and use of Healthcare IT is slightly increasing. German doctors are somewhat embracing the use of these technologies, despite the fact that many agree the use of HIE, specifically, does not reduce organizational cost as anticipated. Nevertheless, doctors state they have realized important HIE benefits such as improved decision-making and the reduction of medical errors. Additionally, German doctors are embracing the Internet less than doctors in other countries, as they are less likely to read online forums, view online videos, and access news from an RSS feed.
Moreover, doctors across all eight countries uniformly agree on two key issues: 1) cost is the main barrier to electronic medical record (EMR) adoption, and 2) patients should have at least some access to and be able to update elements of their EMR. However, compared to other countries, doctors in Germany are less likely to feel that patients should be able to access their EMR.
59
Germany Physician Demographics

8-Country Germany Total
(n=3,700) Gender Male Female Age Under 30 30-39 40-49 50-59 60+ Physician Type Primary Care/General Practice/Family Physician Secondary Care/Specialist Average # of Years Practicing Medicine Average Time Spent Face-to-Face with Patients Location of Primary Work Place Urban/City Suburban/Next to a city Small town/Rural
8-Country Germany Total

(n=3,700) Organization Status (n=500)
(n=500)
73% 27%
77% 23%
54% 7% 39% 172.1
41% 7% 50% 77.2
2% 24% 34% 30% 10%
0% 10% 37% 39% 14%
Average # of Physicians in Organization Primary Work Setting Mostly office - or clinic-based
62% 15% 13% 8% 1% 1% 1% (n=2,604) 28% 44% 28%
82% 9% 6% 3% 0% 0% 1% (n=422) 50% 36% 14%
Exclusively hospital - or lab-based

Mostly hospital - or lab-based Equally hospital-based and office/clinic-based
50% 50% 18.3 79%
50% 50% 17.7 77%
Mostly long-term care facility-based Mostly hospice-based Other Practice Size (among those who work in office/clinic) Solo practice
66% 20% 14%
64% 8% 28%
Single-specialty partnership or group (2 or more physicians) Multi-specialty partnership or group (2 or more physicians)
60
Doctors in Germany experienced large significant increases in electronic alerts/reminders while seeing patients and the ability to electronically access clinical data about a patient seen by a different health organization. However, e-Prescribing, sending electronic order requests, and communicating electronically with clinicians in other organizations are not as robust as the prior year among doctors in Germany.
8-Country Total Healthcare IT I electronically enter patient notes either during or after consultations My organization uses electronic tools to reduce the administrative burden for delivering health care (e.g., e-scheduling or e-billing) I receive electronic alerts/reminders while I am seeing my patients (e.g., prompts regarding contraindications or preventative care) I use computerized clinical decision support systems to help make diagnostic and treatment decisions while I am seeing my patients (e.g., real-time access to evidence-based practice guidelines) HIE I have electronic access to clinical data about a patient who has been seen by a different health organization (e.g., hospital, laboratory) I am electronically notified of my patients interactions with other health organizations (e.g., admissions to hospital) I electronically send prescriptions to pharmacies (e-Prescribing) I electronically send order requests (e.g., for lab, radiology or diagnostic tests) to laboratories 33% 18% 18% 36% 25% 30%* 47%* 20%* 21% 34% 27%* 22% 42% 11% 17% -6% 8% -27% 22% 11% 7%* 49%* 11% 24%* 48% 39%* 11% 4% 31% 10% 17% 50% 77% 0% -43% -37% -9% -29% 4% 2011 58% 54%* 31% 2012 66%* 47% 36%* % change 14% -13% 16% 2011 74% 57% 21% Germany Total 2012 77% 59% 32%* % change 4% 4% 52%
20%
22%*
10%
17%
18%
6%
53%
54%
2%
61
Germany appears to be increasing its adoption of Healthcare IT while maintaining a similar level of HIE adoption from 2011 to 2012. Connected Health Maturity Index: Total Doctors, 2011-2012
Y Axis
60
2011
2012
Germany 2011
Germany 2012
50
Spain Spain US
40
England England
Singapore US
Singapore
30
Canada
20
Canada
10 10 20 30 40 50 60
62
In Germany, unlike most other countries, routine use of HIE has declined. At the same time, the perception that HIE reduces costs has also declined. In 2012, doctors across the eight were less likely to report that HIE reduces costs to their organization or service compared to 2011.

70% 60% 50% 40% 30% 20% 10% 0% 2011 2012 41% 40% Reduces Organizational Cost (8 country total) 59% 52% Routine HIE Users* (8 country total)
Routine HIE Users* (Germany)
21%
19% Reduces organizational Cost (Germany)
9%
5%
63
Although doctors in Germany report many benefits of HIE, such as improved decision-making ability and reduced medical errors since 2011, it appears many hoped-for economic benefits have dropped-off in the past year. Fewer doctors report reduced service costs, reduced patient wait times and reduced risk of litigation. Moreover, improvements in the ability to see more patients daily and achieve a better work-life balance have not been realized; in fact, they appear to be declining.
Germany 2012 73% % Change 3%
69%
66% 63%*
70%
70% 44%
1%
6% -30%
57%* 53%*
48%* 43%*
48% 35%
35% 29%
-16% -34%
-27% -33%
64
For the second year, the main barrier to electronic medical records (EMR) and HIE adoption cited by doctors is cost. Although issues regarding privacy and security of patient information have remained a concern to doctors internationally, 2012 saw a decrease among doctors in Germany who ranked this issue as a concern. In Germany, doctors ranked cost, the difficulty of using EMR systems, lack of technical expertise and lack of easy access to a computer as growing concerns.

8-Country Total
2011 2011 2012 2012 2011
Germany Total
2011 2012 2012
Ranked 1st Most Important

Cost to my organization Concerns about privacy and security of patient data Concern about loss of productivity/too time consuming to input data The system is too difficult to use IT systems that can't 'talk' to each other Lack of technical expertise to manage implementation Lack of easy access to a computer Low IT literacy/lack of training among clinicians and staff 14% 13% 10% 5% 11% 4% 2% 5%
Rank

24% 11% 10% 8% 8% 6% 5% 5%
Rank

9% 23% 8% 6% 9% 2% 2% 4%
Rank

23% 17% 5% 10% 9% 4% 3% 4%
Rank
1 2 4 6 3 7 9 6
1 2 3 4 4 5 6 6
2 1 3 5 2 9 9 7
1 2 6 3 4 7 8 7
Many doctors in Germany state that patients should be able to update information in their EMR. However, compared to other countries, doctors in Germany are less likely to feel that patients should be able to access their EMR. Doctors in Germany are particularly less enthusiastic about allowing patients to update lab test results. Patient Allowed Access to Electronic Medical Record
8-Country Total
8-Country Total No Access 14% Full Access 24% Lab test results Change in symptoms New symptoms New medications 45% 23% 23% 21% 20% 19% 18% 17% 15% 34% 32% 28% 33% 33% 37% 28% 29% 25% 29% 44% 46% 50% 47% 48% 45% 55% 55% 65% Germany Total 53% 23% 23%
25%
25% 29% 24% 22% 17%
42%
38% 34% 42% 39% 39%
33%
37% 37% 35% 39% 44%
Limited Access 62%

Germany Total
Allergic episodes
No access 34% Family medical history
19%
19% 20%
37%
44% 39%
44%
Limited access 54%
Full access 12%
Some information
66
Research Results
Globally, as well as in Germany, most physicians use EMR (91% and 93%, respectively). In both cases, two-thirds or more use it in their own practice. Location of EMR Use

Yes (NET): 95% 93% 93% 92% 91%

87% 83% 82% 76%
73%
68% 59% 39% 27%
65%
63%
67% 60% 46% 34% 27% 37% 37% 58% 51% 43% 47%
Spain
Germany
US
France
Global Total
Singapore
Australia
England
Canada
(n=500)
(n=500)
(n=500)
(n=500)
(n=3,700)
(n=200)
(n=500)
(n=500)
(n=500)
68
Globally, the number of physicians electronically entering patient notes routinely has increased since last year (up 14%). Germany slightly increased routine use (4%) and after the US has the highest proportion of doctors routinely performing this function (77%). I electronically enter patient notes either during or after consultations
4%
1%
1%
14%
14%
19%
27%
22%
Use Routinely
41% 58% 58% 56% 66% 64% 54% 64% 7% 6% 19% 6% 4% 8% 6% 7% 5% 11% 5% 3% 4% 11% 9% 3% 9% 5% 5% 9% 4% 9% 8% 9% 7% 7% 10% 4% 5% 13% 9% 9% 5% 10% 19% 5% 12% 10% 8% 4% 9% 26% 5% 17% 16% 8% 5% 7% 2011 2012 2011 2012 18% 7% 15% 15% 12% 2011 2012 6% 19% 36% 29% 8% 7% 52% 67% 68% 36% 44%
Use Sometimes
78%
74% 77%
72% 73%
Use Rarely
6% 10%
18% 7% 12% 10% 7% 2011 2012
Interested in Using
23%
7% 2% 9% 4%
9%
2011 2012
2011 2012
2011 2012
2011 2012
2011 2012
US
Germany
Spain
France
Global Total
Australia
England
Singapore
Canada
(n=500)
(n=500)
(n=500)
(n=500)
(n=3,700)
(n=500)
(n=500)
(n=200)
(n=500)
69
Globally, the number of physicians who routinely access clinical data about patients seen by different health organizations has increased by 42%. Germany increased its routine use by 77%. I have electronic access to clinical data about a patient who has been seen by a different health organization (e.g., hospital, laboratory)
32%
53%
42%
32%
42%
62%
77%
17%
32% 41% 49% 69% 19% 17% 15% 5% 15% 6% 13% 24% 5% 10% 6% 3% 8% 3% 2011 2012 2011 2012 6% 29% 22% 24% 22% 5% 2011 2012 17% 7% 10% 15% 54% 49%
33% 47%
34% 45%
31% 44%
26% 42%
22% 39% 12%
Use Routinely
29% 34%
Use Sometimes
13% 10% 14% 7% 5%
15% 15% 7% 15% 18% 7% 15% 6% 34% 24% 35% 5% 19% 17% 6% 8% 38% 26% 43% 28% 15% 16% 2011 2012 6% 17% 6% 43% 28% 8%
Use Rarely
7%
37% 37%
24%
11% 8% 2011 2012 8% 9% 7% 10% 7% 2011 2012 14% 10%
4%
2011 2012
2011 2012
2011 2012
Spain
England
Singapore
Global Total
US
Canada
Australia
Germany
France
(n=500)
(n=500)
(n=200)
(n=3,700)
(n=500)
(n=500)
(n=500)
(n=500)
(n=500)
70
Globally, the number of physicians who routinely e-Prescribe increased by 17% since 2011. However, Germany decreased routine e-Prescribing usage by 43%, and has the lowest proportion of physicians routinely e-Prescribing (4%). I electronically send prescriptions to pharmacies (e-Prescribing)
36%
32%
17%
0%
0%
-36%
20%
5% 5% 9% 6% 5% 7%
-43%
4% 5% 8%
25% 36% 49% 65% 17% 13% 7% 11% 21% 5% 12% 10% 7% 2011 2012 8% 16% 43% 14% 8% 39% 49% 6% 10% 6% 33%
18% 21%
8% 10%
12% 12% 8% 9%
8% 6%
8% 5%
11%
10%
7% 9% 11%
7% 5% 11%
Use Routinely
9% 10%
8% 8%
11% 7%
12%
Use Sometimes
47%
7%
52% 55% 57% 59% 43% 57% 58%
44%
Use Rarely
43% 43%
42%
Interested in Using
25%
30% 33% 36% 24% 24%
20%
25%
16% 15% 7% 2011 2012 2011 2012
21% 20%
17% 17%
20% 18%
2011 2012
2011 2012
2011 2012
2011 2012
2011 2012
2011 2012
US
Singapore
Spain
Global Total
England
Canada
France
Australia
Germany
(n=500)
(n=200)
(n=500)
(n=3,700)
(n=500)
(n=500)
(n=500)
(n=500)
(n=500)
71
Globally, there is a 16% increase in the number of physicians reporting they routinely receive electronic alerts/reminders while seeing patients; in Germany there is a 52% increase. I receive electronic alerts/reminders while I am seeing my patients (e.g., prompts regarding contraindications or preventative care)
32%
10%
3%
16%
13%
52%
-4%
12%
21% 34% 45% 46% 45% 40% 44% 37% 38% 31% 36% 31% 35% 15% 32%
27% 26%
17% 19% 7% 11%
Use Routinely
13% 13% 14% 9% 13% 11% 5% 8% 31% 29% 24% 22% 14% 15% 27% 22% 31% 23% 14% 13% 2011 2012 19% 11% 2011 2012 6% 16% 13% 7% 8% 16% 20% 13% 15% 9% 9% 11% 33% 27% 20% 20% 17% 16% 20% 10% 14% 33% 27% 20% 20% 14% 20% 9% 11%
11% 8%
Use Sometimes
Use Rarely
47% 45%
7%
9%
9% 35% 30%
Interested in Using
10%
9%
13% 13% 2011 2012
7%
8%
12%
18% 17%
2011 2012
2011 2012
2011 2012
2011 2012
2011 2012
2011 2012
England
US
Australia
Spain
Global Total
Singapore
Germany
France
Canada
(n=500)
(n=500)
(n=500)
(n=500)
(n=3,700)
(n=200)
(n=500)
(n=500)
(n=500)
72
Globally as well as in Germany, the majority of physicians believe that patients should have at least limited access to their electronic personal health records (85% and 66%, respectively). However, Germany stands out as having the largest proportion of physicians who believe patients should have no access (34%). Access Patient Should Have to Electronic Personal Health Record
34%
31%
30%
29%
24%
22%
21%
18%
12% Full access
60%
65%
63%
57%
61%
68%
No access
14%
Canada
14%
Global Total
13% Spain
11%
France
(n=500)
(n=500)
(n=200)
(n=500)
(n=3,700)
(n=500)
(n=500)
(n=500)
(n=500)
73
Physicians in Germany are least in favor of patients being able to update all demographic information in their personal health record (41%). Demographic Information
95% 90% 89% 88% 88% 87% 86% 86% 80%
41% 55% 79% 73% 65% 62% 63% 60%
57%
All information
Some information

20%
Germany
(n=476)
(n=430)
(n=3,200)
(n=184)
(n=473)
(n=429)
(n=444)
(n=439)
(n=325)
74
Globally, more than half of physicians are in favor of allowing patients to update all information about their family medical history in their health record (55%), compared to a little more than a third of physicians in Germany (37%). Family Medical History
91%
91%
88%
85%
84%
84%
81%
78%
72%
37%
54% 65% 67% 55% 54% 47% 49%
43%
All information
Some information
44% 37% 29% 29% 37%
29%
21%
31%
26%

22% 28%
9% France
9% Singapore
12% US
15%
Global Total
16% Canada
16% England
19%
Germany
Australia
Spain
(n=444)
(n=184)
(n=476)
(n=3,200)
(n=430)
(n=473)
(n=325)
(n=429)
(n=439)
75
More than half of physicians globally feel that patients should be able to update all information about allergic episodes in their health record (55%), compared to slightly more than four out of ten physicians in Germany. Allergic Episodes
90%
85%
83%
83%
81%
80%
79%
77%
74%
44%
57%
70%
55%
62%
54%
49%
52%
48%
All information
Some information
Germany
Singapore
Canada
England
Australia
(n=444)
(n=476)
(n=3,200)
(n=439)
(n=325)
(n=184)
(n=430)
(n=473)
(n=429)
76
Globally and in Germany, three-quarters of physicians are in favor of allowing patients to update at least some information about changes in symptoms in their health record. Change in Symptoms
86%
81%
81%
77%
75%
72%
72%
71%
71%
33% 43% 47% 50% 44%
39%
40%
42% 43% 34%
33%
32%
35% 26%
34%
31%
14% Singapore
19%
19%
23%
25%
28%
28%
29%
29%
France
US
Global Total
Germany
Australia
England
Canada
Spain
(n=184)
(n=444)
(n=476)
(n=3,200)
(n=325)
(n=429)
(n=473)
(n=430)
(n=439)
77
Both globally and in Germany, eight out of ten physicians are in favor of allowing patients to update at least some information about medication side effects in their health record. Medication Side Effects
84%
82%
82%
81%
80%
79%
78%
78%
72%
53%
47%
50%
48%
53%
48%
41%
39%
40% All information
31%
35%
32%
33%
27%
31%
37%
39%
32%
16% France
18% Singapore
18% US
19%
20%
21%
22%
22%
28%
Global Total
Spain
England
Canada
Germany
Australia
(n=444)
(n=184)
(n=476)
(n=3,200)
(n=439)
(n=473)
(n=430)
(n=325)
(n=429)
78
Both globally and in Germany, eight out of ten physicians are in favor of allowing patients to update at least some self-measured metrics information in their health record. Self-Measured Metrics
93%
88%
83%
82%
81%
79%
78%
77%
75%
44% 54% 53%
45%
45%
48%
41%
43%
36% All information
39% 39% 35%
37%
36%
32%
37%
39% 35%
7% Singapore
12% France
17% Germany
18% Global Total
19%
21%
22%
23%
25%
US
Spain
England
Canada
Australia
(n=184)
(n=444)
(n=325)
(n=3,200)
(n=476)
(n=439)
(n=473)
(n=430)
(n=429)
79
The majority of physicians feel that the quality of patient care throughout the healthcare system has improved due to the use of EMR (61%). Physicians in Germany, however, are among the least likely to feel this way (56%). Change in Quality of Patient Care
It has improved
65%
87% 84%
63%
63%
61%
58%
56%
53%
28% 27% 10% 2%

Singapore
It has gotten worse
31%
33%
30%
36%
40% 19%
9% 7%
Spain
7%
England
6%
Canada
4%
France
10%
Global Total
6%
Australia
4%
Germany US
(n=200)
(n=500)
(n=500)
(n=500)
(n=500)
(n=3,700)
(n=500)
(n=500)
(n=500)
80
Physicians in Germany are less likely than physicians in most other countries to have read online forums, viewed an online video, or accessed news from an RSS feed in the past six months. However, they are the most likely to have commented and/or posted to an online article or forum. Internet Usage in the Past Six Months
Global Total
(n=3,700)
Australia
(n=500)
Canada
(n=500)
England
(n=500)
France
(n=500)
Germany
(n=500)
Singapore
(n=200)
Spain
(n=500)
US
(n=500)
Read online forums
71%
70%
76%
77%
51%
61%
74%
66%
82%
52%
48%
53%
58%
52%
45%
50%
49%
57%
29%
17%
17%
28%
17%
45%
35%
33%
24%
19%
12%
15%
18%
25%
12%
29%
35%
17%
12%
5%
8%
15%
7%
10%
28%
24%
10%
12%
19%
13%
10%
19%
14%
11%
12%
9%
81
Doctors Survey: Singapore Country Profile
Research Results
Highlights of Singapore and 8-Country Findings
Key Singapore Findings - Summary
Key study findings for physicians in Singapore revealed that over the last two years, doctors use of healthcare IT and HIE is rising.
Doctors in Singapore especially, are embracing the use of these technologies, despite the fact that many agree the use of HIE, specifically, does not reduce organizational cost as anticipated.
Nevertheless, doctors state they have realized important HIE benefits such as improved decision-making and the reduction of medical errors.
Additionally, doctors in Singapore are embracing the Internet as they are among the most likely to read online forums, follow a colleague or medical professional through social media, and access news from an RSS feed. 1) cost is the main barrier to electronic medical record (EMR) adoption, and 2) patients should have at least some access to and be able to update elements of their EMR.

84
Singapore Physician Demographics

8-Country Singapore Total
8-Country Singapore Total

(n=200)
73% 27%
65% 35%
54% 7% 39% 172.1
53% 4% 44% 222.3
2% 24% 34% 30% 10%
19% 47% 22% 12% 2%
62% 15% 13% 8% 1% 1% 1% (n=2,604) 28% 44% 28%
41% 14% 20% 18% 3% 2% 4% (n=116) 12% 36% 52%

50% 50% 18.3 79%
50% 50% 11.7 70%
66% 20% 14%
85% 14% 2%
85
Doctors in Singapore and abroad increasingly use healthcare IT functions such as patient information recordkeeping as well as alerts and reminders. In Singapore, the use of electronic tools such as ebilling and e-scheduling to reduce administrative burden experienced a large significant increase, whereas globally use of this function decreased.
8-Country Total Healthcare IT I electronically enter patient notes either during or after consultations My organization uses electronic tools to reduce the administrative burden for delivering health care (e.g., e-scheduling or e-billing) I receive electronic alerts/reminders while I am seeing my patients (e.g., prompts regarding contraindications or preventative care) I use computerized clinical decision support systems to help make diagnostic and treatment decisions while I am seeing my patients (e.g., real-time access to evidence-based practice guidelines) HIE I have electronic access to clinical data about a patient who has been seen by a different health organization (e.g., hospital, laboratory) I am electronically notified of my patients interactions with other health organizations (e.g., admissions to hospital) I electronically send prescriptions to pharmacies (e-Prescribing) I electronically send order requests (e.g., for lab, radiology or diagnostic tests) to laboratories 33% 18% 18% 36% 25% 30%* 47%* 20%* 21% 34% 27%* 22% 42% 11% 17% -6% 8% -27% 32% 23% 36% 32% 26% 32% 35% 49%* 19% 49%* 56%* 21% 29% 49%* 53% -17% 36% 75% -19% -9% 40% 2011 58% 54%* 31% 2012 66%* 47% 36%* % change 14% -13% 16% 2011 41% 38% 31% Singapore Total 2012 52%* 57%* 35% % change 27% 50% 13%
20%
22%*
10%
27%
26%
-4%
53%
54%
2%
86
Although Singapore lagged a bit behind Spain in 2011 in adoption of Healthcare IT and HIE, Singapore as well as the US appear to be catching up. Connected Health Maturity Index: Total Doctors, 2011-2012
Y Axis
60
2011
2012
Singapore 2011
Singapore 2012
50
Spain Spain US
40
England England
Singapore US
Singapore
30
Canada
20
Canada
10 10 20 30 40 50 60
87
Although doctors in Singapore report many benefits of HIE, such as improved decision-making ability and reduced medical errors, it appears many hoped-for economic benefits have dropped-off in the past year. Fewer doctors report reduced service costs, reduced patient wait times and reduced risk of litigation. Moreover, improvements in the ability to see more patients daily and achieve a better work-life balance have not been realized; in fact, they appear to be declining.
Singapore 2012 86% % Change 8%
81%
78% 66%*
83%
78% 53%
2%
0% -20%
73%* 71%*
73% 69%*
55% 53%
64% 53%
-25% -25%
-12% -23%
88
For the second year, the main barrier to electronic medical records (EMR) and HIE adoption cited by doctors is cost. Although issues regarding privacy and security of patient information have remained a concern to doctors internationally, 2012 saw a large decrease among doctors in Singapore who ranked this issue as a concern. In Singapore, doctors ranked cost, lack of easy access to a computer, and IT systems that cant talk to each other as growing concerns.

8-Country Total
2011 2011 2012 2012 2011
Singapore Total
2011 2012 2012

Rank

24% 11% 10% 8% 8% 6% 5% 5%
Rank

7% 21% 9% 3% 3% 6% 4% 7%
Rank

28% 6% 14% 3% 6% 7% 9% 6%
Rank
1 2 4 6 3 7 9 6
1 2 3 4 4 5 6 6
3 1 2 7 7 4 6 3
1 5 2 7 5 4 3 5
Many doctors in Singapore state that patients should be able to update information in their EMR such as demographic information, self-measured metrics, and both personal and family medical history. Doctors in Singapore, as well as those in the other study countries, however, are less enthusiastic about patients updating lab test results. Patient Allowed Access to Electronic Medical Record
8-Country Total
8-Country Total No Access 14% Full Access 24% Lab test results Change in symptoms New symptoms New medications 45% 23% 23% 21% 20% 19% 18% 17% 15% 34% 32% 28% 33% 33% 37% 28% 29% 25% 29% 44% 46% 50% 47% 48% 45% 55% 55% 65% Singapore Total 39% 14% 13% 22% 24% 43% 38% 29% 36% 43% 48% 49% 54% 47% 54% 54% 54%
Limited Access 62%

10% 36% 18% 35%
Singapore Total
Self-measured metrics No access 7% Full access 30% Limited access 63% 7% 39% 20% 26% 9% 37%
Allergic episodes
12% 33%
Some information
55%
All information
90
Research Results
Globally, the number of physicians electronically entering patient notes routinely has increased since last year (up 14%). Singapore experienced a large increase of routine use (27%). I electronically enter patient notes either during or after consultations
4%
1%
1%
14%
14%
19%
27%
22%
Use Routinely
41% 58% 58% 56% 66% 64% 54% 64% 7% 6% 19% 6% 4% 8% 6% 7% 5% 11% 5% 3% 4% 11% 9% 3% 9% 5% 5% 9% 4% 9% 8% 9% 7% 7% 10% 4% 5% 13% 9% 9% 5% 10% 19% 5% 12% 10% 8% 4% 9% 26% 5% 17% 16% 8% 5% 7% 2011 2012 2011 2012 18% 7% 15% 15% 12% 2011 2012 6% 19% 36% 29% 8% 7% 52% 67% 68% 36% 44%
Use Sometimes
78%
74% 77%
72% 73%
Use Rarely
6% 10%
18% 7% 12% 10% 7% 2011 2012
Interested in Using
23%
7% 2% 9% 4%
9%
2011 2012
2011 2012
2011 2012
2011 2012
2011 2012
US
Germany
Spain
France
Global Total
Australia
England
Singapore
Canada
(n=500)
(n=500)
(n=500)
(n=500)
(n=3,700)
(n=500)
(n=500)
(n=200)
(n=500)
92
Globally, the number of physicians who routinely access clinical data about patients seen by different health organizations has increased by 42%. Singapore experienced a substantial increase of routine use (53%). I have electronic access to clinical data about a patient who has been seen by a different health organization (e.g., hospital, laboratory)
32%
53%
42%
32%
42%
62%
77%
17%
32% 41% 49% 69% 19% 17% 15% 5% 15% 6% 13% 24% 5% 10% 6% 3% 8% 3% 2011 2012 2011 2012 6% 29% 22% 24% 22% 5% 2011 2012 17% 7% 10% 15% 54% 49%
33% 47%
34% 45%
31% 44%
26% 42%
22% 39% 12%
Use Routinely
29% 34%
Use Sometimes
13% 10% 14% 7% 5%
15% 15% 7% 15% 18% 7% 15% 6% 34% 24% 35% 5% 19% 17% 6% 8% 38% 26% 43% 28% 15% 16% 2011 2012 6% 17% 6% 43% 28% 8%
Use Rarely
7%
37% 37%
24%
11% 8% 2011 2012 8% 9% 7% 10% 7% 2011 2012 14% 10%
4%
2011 2012
2011 2012
2011 2012
Spain
England
Singapore
Global Total
US
Canada
Australia
Germany
France
(n=500)
(n=500)
(n=200)
(n=3,700)
(n=500)
(n=500)
(n=500)
(n=500)
(n=500)
93
Globally, the number of physicians who routinely e-Prescribe increased by 17% since last year. Singapore increased routine e-Prescribing usage by 36%, that now, almost half of physicians routinely e-Prescribe (49%). I electronically send prescriptions to pharmacies (e-Prescribing)
36%
32%
17%
0%
0%
-36%
20%
5% 5% 9% 6% 5% 7%
-43%
4% 5% 8%
25% 36% 49% 65% 17% 13% 7% 11% 21% 5% 12% 10% 7% 2011 2012 8% 16% 43% 14% 8% 39% 49% 6% 10% 6% 33%
18% 21%
8% 10%
12% 12% 8% 9%
8% 6%
8% 5%
11%
10%
7% 9% 11%
7% 5% 11%
Use Routinely
9% 10%
8% 8%
11% 7%
12%
Use Sometimes
47%
7%
52% 55% 57% 59% 43% 57% 58%
44%
Use Rarely
43% 43%
42%
Interested in Using
25%
30% 33% 36% 24% 24%
20%
25%
16% 15% 7% 2011 2012 2011 2012
21% 20%
17% 17%
20% 18%
2011 2012
2011 2012
2011 2012
2011 2012
2011 2012
2011 2012
US
Singapore
Spain
Global Total
England
Canada
France
Australia
Germany
(n=500)
(n=200)
(n=500)
(n=3,700)
(n=500)
(n=500)
(n=500)
(n=500)
(n=500)
94
Globally, there was a 16% increase in the number of physicians reporting they routinely receive electronic alerts/reminders while seeing patients; in Singapore there was a 13% increase. I receive electronic alerts/reminders while I am seeing my patients (e.g., prompts regarding contraindications or preventative care)
32%
10%
3%
16%
13%
52%
-4%
12%
21% 34% 45% 46% 45% 40% 44% 37% 38% 31% 36% 31% 35% 15% 32%
27% 26%
17% 19% 7% 11%
Use Routinely
13% 13% 14% 9% 13% 11% 5% 8% 31% 29% 24% 22% 14% 15% 27% 22% 31% 23% 14% 13% 2011 2012 19% 11% 2011 2012 6% 16% 13% 7% 8% 16% 20% 13% 15% 9% 9% 11% 33% 27% 20% 20% 17% 16% 20% 10% 14% 33% 27% 20% 20% 14% 20% 9% 11%
11% 8%
Use Sometimes
Use Rarely
47% 45%
7%
9%
9% 35% 30%
Interested in Using
10%
9%
13% 13% 2011 2012
7%
8%
12%
18% 17%
2011 2012
2011 2012
2011 2012
2011 2012
2011 2012
2011 2012
England
US
Australia
Spain
Global Total
Singapore
Germany
France
Canada
(n=500)
(n=500)
(n=500)
(n=500)
(n=3,700)
(n=200)
(n=500)
(n=500)
(n=500)
95
Globally as well as in Singapore, the majority of physicians believe that patients should have at least limited access to their electronic personal health records (85% and 93%, respectively). Access Patient Should Have to Electronic Personal Health Record
34%
31%
30%
29%
24%
22%
21%
18%
12% Full access
60%
65%
63%
57%
61%
68%
No access
14%
Canada
14%
Global Total
13% Spain
11%
France
(n=500)
(n=500)
(n=200)
(n=500)
(n=3,700)
(n=500)
(n=500)
(n=500)
(n=500)
96
Just over half of physicians in Singapore are in favor of patients being able to update all demographic information in their personal health record (55%), compared to 65% of physicians globally. Demographic Information
95% 90% 89% 88% 88% 87% 86% 86% 80%
41% 55% 79% 73% 65% 62% 63% 60%
57%
All information
Some information

20%
Germany
(n=476)
(n=430)
(n=3,200)
(n=184)
(n=473)
(n=429)
(n=444)
(n=439)
(n=325)
97
More than half of physicians, both globally and in Singapore (55% and 54% respectively), are in favor of allowing patients to update all information about their family medical history in their health record. Family Medical History
91%
91%
88%
85%
84%
84%
81%
78%
72%
37%
54% 65% 67% 55% 54% 47% 49%
43%
All information
Some information
44% 37% 29% 29% 37%
29%
21%
31%
26%

22% 28%
9% France
9% Singapore
12% US
15%
Global Total
16% Canada
16% England
19%
Germany
Australia
Spain
(n=444)
(n=184)
(n=476)
(n=3,200)
(n=430)
(n=473)
(n=325)
(n=429)
(n=439)
98
More than half of physicians, both globally and in Singapore (55% and 54% respectively, feel that patients should be able to update all information about allergic episodes in their health record. Allergic Episodes
90%
85%
83%
83%
81%
80%
79%
77%
74%
44%
57%
70%
55%
62%
54%
49%
52%
48%
All information
Some information
Germany
Singapore
Canada
England
Australia
(n=444)
(n=476)
(n=3,200)
(n=439)
(n=325)
(n=184)
(n=430)
(n=473)
(n=429)
99
Globally, three-quarters of physicians are in favor of allowing patients to update at least some information about changes in symptoms in their health record. In Singapore more than eight out of ten physicians feel that patients should be able to update at least some of this information. Change in Symptoms
86%
81%
81%
77%
75%
72%
72%
71%
71%
33% 43% 47% 50% 44%
39%
40%
42% 43% 34%
33%
32%
35% 26%
34%
31%
14% Singapore
19%
19%
23%
25%
28%
28%
29%
29%
France
US
Global Total
Germany
Australia
England
Canada
Spain
(n=184)
(n=444)
(n=476)
(n=3,200)
(n=325)
(n=429)
(n=473)
(n=430)
(n=439)
100
Both globally and in Singapore, eight out of ten physicians are in favor of allowing patients to update at least some information about medication side effects in their health record. Medication Side Effects
84%
82%
82%
81%
80%
79%
78%
78%
72%
53%
47%
50%
48%
53%
48%
41%
39%
40% All information
31%
35%
32%
33%
27%
31%
37%
39%
32%
16% France
18% Singapore
18% US
19%
20%
21%
22%
22%
28%
Global Total
Spain
England
Canada
Germany
Australia
(n=444)
(n=184)
(n=476)
(n=3,200)
(n=439)
(n=473)
(n=430)
(n=325)
(n=429)
101
Globally, eight out of ten physicians are in favor of allowing patients to update at least some selfmeasured metrics information in their health record. Physicians in Singapore (93%) are most likely to be in favor of this type of updating. Self-Measured Metrics
93%
88%
83%
82%
81%
79%
78%
77%
75%
44% 54% 53%
45%
45%
48%
41%
43%
36% All information
39% 39% 35%
37%
36%
32%
37%
39% 35%
7% Singapore
12% France
17% Germany
18% Global Total
19%
21%
22%
23%
25%
US
Spain
England
Canada
Australia
(n=184)
(n=444)
(n=325)
(n=3,200)
(n=476)
(n=439)
(n=473)
(n=430)
(n=429)
102
The majority of physicians feel that the quality of patient care throughout the healthcare system has improved due to the use of EMR (61%). Physicians in Singapore are most likely to feel this way (87%). Change in Quality of Patient Care
It has improved
65%
87% 84%
63%
63%
61%
58%
56%
53%
28% 27% 10% 2%

Singapore
It has gotten worse
31%
33%
30%
36%
40% 19%
9% 7%
Spain
7%
England
6%
Canada
4%
France
10%
Global Total
6%
Australia
4%
Germany US
(n=200)
(n=500)
(n=500)
(n=500)
(n=500)
(n=3,700)
(n=500)
(n=500)
(n=500)
103
Globally and in Singapore, seven out of ten physicians have read online forums in the past six months. Physicians in Singapore are more apt to follow a colleague or medical professional through social media than in any other country, and physicians in Singapore and Spain are the most likely to access news from an RSS feed. Internet Usage in the Past Six Months
Global Total
(n=3,700)
Australia
(n=500)
Canada
(n=500)
England
(n=500)
France
(n=500)
Germany
(n=500)
Singapore
(n=200)
Spain
(n=500)
US
(n=500)
Read online forums
71%
70%
76%
77%
51%
61%
74%
66%
82%
52%
48%
53%
58%
52%
45%
50%
49%
57%
29%
17%
17%
28%
17%
45%
35%
33%
24%
19%
12%
15%
18%
25%
12%
29%
35%
17%
12%
5%
8%
15%
7%
10%
28%
24%
10%
12%
19%
13%
10%
19%
14%
11%
12%
9%
104
Doctors Survey: England Country Profile
Research Results
Highlights of England and 8-Country Findings
Key England Findings - Summary
Key study findings for physicians in England revealed that over the last two years, doctors use of healthcare IT and HIE has risen slightly.
Doctors in England are embracing the use of these technologies to some extent, despite the fact that many agree that the use of HIE, specifically, does not reduce organisational cost as anticipated.
Doctors in England experienced a decrease in their electronic communication with clinicians in other organisations.
Nevertheless, doctors state that they have gained important HIE benefits such as improved decision-making and the reduction of medical errors.
Additionally, doctors in England are embracing the Internet as they are among the most likely to read online forums and view online videos.
1) Cost is the main barrier to electronic medical record (EMR) adoption, and 2) Patients should have at least some access to and be able to update elements of their EMR.
107

England Physician Demographics

8-Country England Total
(n = 3700) Gender Male Female Age Under 30 30-39 40-49 50-59 60+ Physician Type Primary Care/General Practice/Family Physician Secondary Care/Specialist Average # of Years Practising Medicine Average Time Spent Face-to-Face with Patients Location of Primary Work Place Urban/City Suburban/Next to a city Small town/Rural
8-Country England Total

(n = 3700) Organisation Status (n = 500)
(n = 500)
73% 27%
77% 23%
54% 7% 39% 172.1
93% 1% 6% 273.6
2% 24% 34% 30% 10%
2% 31% 39% 23% 6%
Average # of Physicians in Organisation Primary Work Setting Mostly surgery- or clinic-based
62% 15% 13% 8% 1% 1% 1%
52% 28% 13% 5% 0% 1% 0% (n = 287) 4% 47% 48%
Exclusively hospital- or lab-based

Mostly hospital- or lab-based Equally hospital-based and surgery/clinic-based
50% 50% 18.3 79%
50% 50% 18.7 70%
Mostly long-term care facility-based Mostly hospice-based Other
Practice Size (among those who work in surgery/clinic) (n = 2604) Solo practice 28% 44% 28%
66% 20% 14%
70% 20% 9%
Single-speciality partnership or group (2 or more physicians) Multi-speciality partnership or group (2 or more physicians)
108
Doctors in England and abroad increasingly use electronic means to enter patient notes and access clinical data about patients seen by different health organisations. However, the use of electronic tools such as e-billing and e-scheduling to reduce the administrative burden has not been as robust as in the previous year. Furthermore, doctors are less likely this year to communicate electronically with clinicians in other organisations.
8-Country Total Healthcare IT I enter patient notes electronically either during or after consultations My organisation uses electronic tools to reduce the administrative burden for delivering health care (e.g., e-scheduling or e-billing) I receive electronic alerts/reminders while I am seeing my patients (e.g., prompts regarding contraindications or preventative care) I use computerised clinical decision support systems to help make diagnostic and treatment decisions while I am seeing my patients (e.g., real-time access to evidence-based practice guidelines) HIE I have electronic access to clinical data about a patient who has been seen by a different health organisation (e.g., hospital, laboratory) I am notified electronically of my patients interactions with other health organisations (e.g., admissions to hospital) I send prescriptions to pharmacies electronically (e-Prescribing) I send order requests (e.g., for lab, radiology or diagnostic tests) to laboratories electronically 33% 18% 18% 36% 25% 30%* 47%* 20%* 21% 34% 27%* 22% 42% 11% 17% -6% 8% -27% 41% 25% 12% 44% 35% 39%* 64% 54%* 29% 12% 46% 33% 31% 60% 32% 16% 0% 5% -6% -21% -6% 2011 58% 54%* 31% 2012 66%* 47% 36%* % change 14% -13% 16% 2011 54% 36%* 45% England Total 2012 64%* 29% 46% % change 19% -19% 2%
20%
22%*
10%
21%
24%
14%
I send or receive referrals electronically to/from health professionals in other organisations (e.g., for specialist appointments)
I communicate electronically with clinicians in other organisations (e.g., via secure email) I receive clinical results electronically that populate my patients electronic medical records *Significant difference between 2011 and 2012; p<.05
53%
54%
2%
109
In 2011, doctors in Spain had the highest adoption rate for Healthcare IT and HIE. This trend continued in 2012. England experienced a slight increase in adoption of Healthcare IT and HIE from 2011 to 2012. Connected Health Maturity Index: Total Doctors, 2011-2012
Y Axis
60
2011
2012
England 2011
England 2012
50
Spain Spain US
40
England England
Singapore US
Singapore
30
Canada
20
Canada
10 10 20 30 40 50 60
110
In England (as well as in the other seven countries), routine use of HIE is on the rise. At the same time, the perception that HIE reduces costs is going down. In 2012 doctors were less likely to report that HIE reduces costs to their organisation or service compared to 2011.

60% 52% 50% 48% 40%
50%
41%
Routine HIE Users* (8 country total) 31% 29% 21% Reduces Organizational Cost (8 country total) Routine HIE Users* (England) Reduces organizational Cost (England)
30% 19%
20%
10%
0% 2011 2012
111
Although doctors in England report many benefits of HIE, such as improved decision-making ability and reduced medical errors since 2011, it appears many hoped-for economic benefits have dropped off in the past year. Slightly fewer doctors report reduced service costs, reduced patient waiting times, number of patients that can be seen per day, and reduced risk of litigation. Moreover, improvements in the ability to achieve a better work-life balance have not been realised; in fact, they have significantly declined.
8-Country Total 2011 Improved diagnostic decisions Improved quality of treatment decisions Reduction in medical errors Reduced costs for my own organisation/service Reduced waiting lists/waiting times Increased numbers of patients that can be seen per day Reduced risk of litigation Improved work-life balance 68% 69% 73% 60% 48%* 46%* 57%* 47%* 2012 74%* 74% 76% 47% 38% 34% 44% 34% % Change 9% 7% 4% -22% -21% -26% -23% -28% 2011 70%
England 2012 79%* % Change 13%
71%
74% 58%
79%*
79% 56%
11%
7% -3%
45% 41%
58% 45%*
44% 37%
52% 35%
-2% -10%
-10% -22%
112
For the second year, doctors globally indicate the main barrier to electronic medical records (EMR) and HIE adoption is cost. Although issues regarding privacy and security of patient information have remained a concern to doctors internationally, 2012 saw a decrease among doctors in England who ranked this issue as a concern. In England, there is growing concern about cost, loss of productivity, difficulty of using EMR systems, lack of technical expertise, lack of easy access to a computer and lack of staff training.

8-Country Total 2011 Ranked 1st Most Important Cost to my organisation Concerns about privacy and security of patient data Concern about loss of productivity/too time consuming to input data The system is too difficult to use IT systems that can't 'talk' to each other Lack of technical expertise to manage implementation Lack of easy access to a computer Low IT literacy/lack of training among clinicians and staff 14% 13% 10% 5% 11% 4% 2% 5% 2011 2012 Ranked 1st Most Important 24% 11% 10% 8% 8% 6% 5% 5% 2012 2011 Ranked 1st Most Important 14% 17% England Total 2011 2012 Ranked 1st Most Important 25% 11% 2012
Rank
Rank
Rank
Rank
1 2 4 6 3 7 9 6
1 2 3 4 4 5 6 6
3 2
1 3
5%
5% 18%
5
5 1
7%
7% 13%
4
4 2
4%
1% 2%
6
9 8
7%
5% 4%
4
5 6
Many doctors in England state that patients should be able to update information in their EMR such as demographics and family medical history. Doctors in England, as well as those in the other study countries, however, are less enthusiastic about patients updating lab test results. Patient Allowed Access to Electronic Medical Record
8-Country Total
8-Country Total No Access 14% Full Access 24% Lab test results Change in symptoms New symptoms New medications 45% 23% 23% 21% 20% 19% 18% 17% 15% 34% 32% 28% 33% 33% 37% 28% 29% 25% 29% 44% 46% 50% 47% 48% 45% 55% 55% 65% 28% 29% 34% 28% 21% 22% 23% 16% England Total 61% 32% 30% 25% 35% 31% 37% 25% 37% 17% 22% 40% 41% 41% 37% 48% 41% 52% 47%
Limited Access 62%

England Total
No access 6% Full access 34%
Allergic episodes
Limited access 60%
12% 25%
Some information
62%
All information
114
Research Results
Globally, as well as in England, most physicians use EMR (91% and 82% respectively). Whereas globally six out of ten physicians use it in their own practice, in England physicians are more likely to use it in their hospital or clinic than in their own practice. Location of EMR Use

Yes (NET): 95% 93% 93% 92%

91% 87% 83% 82% 76%
73%
68% 59% 39% 27%
65%
63%
67% 60% 46% 34% 27% 37% 37% 58% 51% 43% 47%
Spain
Germany
US
France
Global Total
Singapore
Australia
England
Canada
(n = 500)
(n = 500)
(n = 500)
(n = 500)
(n = 3700)
(n = 200)
(n = 500)
(n = 500)
(n = 500)
Note: Weighted Data Base: AUS, CAN, FRANCE, GERMANY, SINGAPORE, SPAIN, England Or US And Currently Practising Medicine Q615. Do you use electronic patient medical records in your practice (excluding billing systems)?
116
Globally, the number of physicians entering patient notes electronically and routinely has increased since last year (up 14%). England increased its routine use by 19%. I enter patient notes electronically either during or after consultations
4%
1%
1%
14%
14%
19%
27%
22%
Use Routinely
41% 58% 58% 56% 66% 64% 54% 64% 7% 6% 19% 6% 4% 8% 6% 7% 5% 11% 5% 3% 4% 11% 9% 3% 9% 5% 5% 9% 4% 9% 8% 9% 7% 7% 10% 4% 5% 13% 9% 9% 5% 10% 19% 5% 12% 10% 8% 4% 9% 26% 5% 17% 16% 8% 5% 7% 2011 2012 2011 2012 18% 7% 15% 15% 12% 2011 2012 6% 19% 36% 29% 8% 7% 52% 67% 68% 36% 44%
Use Sometimes
78%
74% 77%
72% 73%
Use Rarely
6% 10%
18% 7% 12% 10% 7% 2011 2012
Interested in Using
23%
7% 2% 9% 4%
9%
2011 2012
2011 2012
2011 2012
2011 2012
2011 2012
US
Germany
Spain
France
Global Total
Australia
England
Singapore
Canada
(n = 500)
(n = 500)
(n = 500)
(n = 500)
(n = 3700)
(n = 500)
(n = 500)
(n = 200)
(n = 500)
117
Globally, the number of physicians who routinely access clinical data about patients seen by different health organisations has increased by 42%. England increased its routine use by 32%. I have electronic access to clinical data about a patient who has been seen by a different health organisation (e.g. hospital, laboratory)
32%
53%
42%
32%
42%
62%
77%
17%
32% 41% 49% 69% 19% 17% 15% 5% 15% 6% 13% 24% 5% 10% 6% 3% 8% 3% 2011 2012 2011 2012 6% 29% 22% 24% 22% 5% 2011 2012 17% 7% 10% 15% 54% 49%
33% 47%
34% 45%
31% 44%
26% 42%
22% 39% 12%
Use Routinely
29% 34%
Use Sometimes
13% 10% 14% 7% 5%
15% 15% 7% 15% 18% 7% 15% 6% 34% 24% 35% 5% 19% 17% 6% 8% 38% 26% 43% 28% 15% 16% 2011 2012 6% 17% 6% 43% 28% 8%
Use Rarely
7%
37% 37%
24%
11% 8% 2011 2012 8% 9% 7% 10% 7% 2011 2012 14% 10%
4%
2011 2012
2011 2012
2011 2012
Spain
England
Singapore
Global Total
US
Canada
Australia
Germany
France
(n = 500)
(n = 500)
(n = 200)
(n = 3700)
(n = 500)
(n = 500)
(n = 500)
(n = 500)
(n = 500)
118
Globally, around two out of ten physicians routinely e-Prescribe. Routine e-Prescribing usage in England remained at the same level (12%) from 2011 to 2012. I send prescriptions to pharmacies electronically (e-Prescribing)
36%
32%
17%
0%
0%
-36%
20%
5% 5% 9% 6% 5% 7%
-43%
4% 5% 8%
25% 36% 49% 65% 17% 13% 7% 11% 21% 5% 12% 10% 7% 2011 2012 8% 16% 43% 14% 8% 39% 49% 6% 10% 6% 33%
18% 21%
8% 10%
12% 12% 8% 9%
8% 6%
8% 5%
11%
10%
7% 9% 11%
7% 5% 11%
Use Routinely
9% 10%
8% 8%
11% 7%
12%
Use Sometimes
47%
7%
52% 55% 57% 59% 43% 57% 58%
44%
Use Rarely
43% 43%
42%
Interested in Using
25%
30% 33% 36% 24% 24%
20%
25%
16% 15% 7% 2011 2012 2011 2012
21% 20%
17% 17%
20% 18%
2011 2012
2011 2012
2011 2012
2011 2012
2011 2012
2011 2012
US
Singapore
Spain
Global Total
England
Canada
France
Australia
Germany
(n = 500)
(n = 200)
(n = 500)
(n = 3700)
(n = 500)
(n = 500)
(n = 500)
(n = 500)
(n = 500)
119
For the second consecutive year, physicians in England are most likely to report that they routinely receive electronic alerts/reminders while seeing patients. I receive electronic alerts/reminders while I am seeing my patients (e.g., prompts regarding contraindications or preventative care)
32%
10%
3%
16%
13%
52%
-4%
12%
21% 34% 45% 46% 45% 40% 44% 37% 38% 31% 36% 31% 35% 15% 32%
27% 26%
17% 19% 7% 11%
Use Routinely
13% 13% 14% 9% 13% 11% 5% 8% 31% 29% 24% 22% 14% 15% 27% 22% 31% 23% 14% 13% 2011 2012 19% 11% 2011 2012 6% 16% 13% 7% 8% 16% 20% 13% 15% 9% 9% 11% 33% 27% 20% 20% 17% 16% 20% 10% 14% 33% 27% 20% 20% 14% 20% 9% 11%
11% 8%
Use Sometimes
Use Rarely
47% 45%
7%
9%
9% 35% 30%
Interested in Using
10%
9%
13% 13% 2011 2012
7%
8%
12%
18% 17%
2011 2012
2011 2012
2011 2012
2011 2012
2011 2012
2011 2012
England
US
Australia
Spain
Global Total
Singapore
Germany
France
Canada
(n = 500)
(n = 500)
(n = 500)
(n = 500)
(n = 3700)
(n = 200)
(n = 500)
(n = 500)
(n = 500)
120
Among all countries, physicians in England are the most likely to believe that patients should have full access to their electronic personal health records (34%). Access Patient Should Have to Electronic Personal Health Record
34%
31%
30%
29%
24%
22%
21%
18%
12% Full access
60%
65%
63%
57%
61%
68%
No access
14%
Canada
14%
Global Total
13% Spain
11%
France
(n = 500)
(n = 500)
(n = 200)
(n = 500)
(n = 3700)
(n = 500)
(n = 500)
(n = 500)
(n = 500)
121
Nine out of ten physicians, globally and in England, are in favour of patients being able to update at least some demographic information in their personal health record. Demographic Information
95% 90% 89% 88% 88% 87% 86% 86% 80%
41% 55% 79% 73% 65% 62% 63% 60%
57%
All information
Some information

20%
Germany
(n = 476)
(n = 430)
(n = 3200)
(n = 184)
(n = 473)
(n = 429)
(n = 444)
(n = 439)
(n = 325)
122
More than half of physicians globally (55%) and just under half of physicians in England (47%) are in favour of allowing patients to update all information about their family medical history in their health record. Family Medical History
91%
91%
88%
85%
84%
84%
81%
78%
72%
37%
54% 65% 67% 55% 54% 47% 49%
43%
All information
Some information
44% 37% 29% 29% 37%
29%
21%
31%
26%

22% 28%
9% France
9% Singapore
12% US
15%
Global Total
16% Canada
16% England
19%
Germany
Australia
Spain
(n = 444)
(n = 184)
(n = 476)
(n = 3200)
(n = 430)
(n = 473)
(n = 325)
(n = 429)
(n = 439)
123
More than half of physicians, both globally and in England, feel that patients should be able to update all information about allergic episodes in their health record (55% and 52% respectively). Allergic Episodes
90%
85%
83%
83%
81%
80%
79%
77%
74%
44%
57%
70%
55%
62%
54%
49%
52%
48%
All information
Some information
Germany
Singapore
Canada
England
Australia
(n = 444)
(n = 476)
(n = 3200)
(n = 439)
(n = 325)
(n = 184)
(n = 430)
(n = 473)
(n = 429)
124
Globally, over three quarters of physicians are in favour of allowing patients to update at least some information about changes in symptoms in their health record. In England, seven out of ten physicians feel that patients should be able to update at least some of this information. Change in Symptoms
86%
81%
81%
77%
75%
72%
72%
71%
71%
33% 43% 47% 50% 44%
39%
40%
42% 43% 34%
33%
32%
35% 26%
34%
31%
14% Singapore
19%
19%
23%
25%
28%
28%
29%
29%
France
US
Global Total
Germany
Australia
England
Canada
Spain
(n = 184)
(n = 444)
(n = 476)
(n = 3200)
(n = 325)
(n = 429)
(n = 473)
(n = 430)
(n = 439)
125
Both globally and in England, eight out of ten physicians are in favour of allowing patients to update at least some information about medication side effects in their health record. Medication Side Effects
84%
82%
82%
81%
80%
79%
78%
78%
72%
53%
47%
50%
48%
53%
48%
41%
39%
40% All information
31%
35%
32%
33%
27%
31%
37%
39%
32%
16% France
18% Singapore
18% US
19%
20%
21%
22%
22%
28%
Global Total
Spain
England
Canada
Germany
Australia
(n = 444)
(n = 184)
(n = 476)
(n = 3200)
(n = 439)
(n = 473)
(n = 430)
(n = 325)
(n = 429)
126
Both globally and in England, eight out of ten physicians are in favour of allowing patients to update at least some self-measured metrics information in their health record. Self-Measured Metrics
93%
88%
83%
82%
81%
79%
78%
77%
75%
44% 54% 53%
45%
45%
48%
41%
43%
36% All information
39% 39% 35%
37%
36%
32%
37%
39% 35%
7% Singapore
12% France
17% Germany
18% Global Total
19%
21%
22%
23%
25%
US
Spain
England
Canada
Australia
(n = 184)
(n = 444)
(n = 325)
(n = 3200)
(n = 476)
(n = 439)
(n = 473)
(n = 430)
(n = 429)
127
The majority of physicians (61%) feel that the quality of patient care throughout the healthcare system has improved due to the use of EMR. Two thirds of physicians in England feel this way. Change in Quality of Patient Care
It has improved
65%
87% 84%
63%
63%
61%
58%
56%
53%
28% 27% 10% 2%

Singapore
It has gotten worse
31%
33%
30%
36%
40% 19%
9% 7%
Spain
7%
England
6%
Canada
4%
France
10%
Global Total
6%
Australia
4%
Germany US
(n = 200)
(n = 500)
(n = 500)
(n = 500)
(n = 500)
(n = 3700)
(n = 500)
(n = 500)
(n = 500)
128
Physicians in England are among the most likely to read online forums (77%) and view online videos (58%). Internet Usage in the Past Six Months
Global Total
(n = 3700)
Australia
(n = 500)
Canada
(n = 500)
England
(n = 500)
France
(n = 500)
Germany
(n = 500)
Singapore
(n = 200)
Spain
(n = 500)
US
(n = 500)
Read online forums
71%
70%
76%
77%
51%
61%
74%
66%
82%
Viewed an online video Commented on and/or posted to an online article or forum Accessed news from an RSS feed 'Followed' a colleague or medical professional through Twitter or other social media platform I do not use the Internet for these activities.
52%
48%
53%
58%
52%
45%
50%
49%
57%
29%
17%
17%
28%
17%
45%
35%
33%
24%
19%
12%
15%
18%
25%
12%
29%
35%
17%
12%
5%
8%
15%
7%
10%
28%
24%
10%
12%
19%
13%
10%
19%
14%
11%
12%
9%
129
Doctors Survey: France Country Profile
Research Results
Highlights of France and 8-Country Findings
Key France Findings - Summary
Key study findings for French physicians revealed that over the last two years, doctors adoption of healthcare IT and HIE slightly decreased. Despite the fact that many agree the use of HIE, specifically, does not reduce organizational cost as anticipated, French doctors experienced a large significant increase in being able to electronically send or receive referrals to/from health professionals in other organizations. Unlike other study countries, in France routine use of HIE has declined. Nevertheless, doctors state they have realized important HIE benefits such as improved decision-making and the reduction of medical errors. French doctors are embracing the Internet (somewhat), but less so than doctors in other countries, as they are less likely to engage with online forums in terms of both reading them and commenting/posting to them. Moreover, doctors across all eight countries uniformly agree on two key issues: 1) cost is the main barrier to electronic medical record (EMR) adoption, and 2) patients should have at least some access to and be able to update elements of their EMR.
132
France Physician Demographics

8-Country France Total
8-Country France Total

(n=500)
73% 27%
74% 26%
54% 7% 39% 172.1
41% 6% 51% 138.5
2% 24% 34% 30% 10%
1% 21% 28% 38% 12%
62% 15% 13% 8% 1% 1% 1% (n=2,604) 28% 44% 28%
60% 21% 15% 2% 0% 1% 1% (n=312) 50% 33% 17%

50% 50% 18.3 79%
50% 50% 19.5 83%
66% 20% 14%
56% 16% 28%
133
France experienced a large significant increase of doctors electronically sending or receiving referrals to/from health professionals in other organizations. However, several other aspects of healthcare IT and HIE functions are not as robust as in the prior year in France.
8-Country Total Healthcare IT I electronically enter patient notes either during or after consultations My organization uses electronic tools to reduce the administrative burden for delivering health care (e.g., e-scheduling or e-billing) I receive electronic alerts/reminders while I am seeing my patients (e.g., prompts regarding contraindications or preventative care) I use computerized clinical decision support systems to help make diagnostic and treatment decisions while I am seeing my patients (e.g., real-time access to evidence-based practice guidelines) HIE I have electronic access to clinical data about a patient who has been seen by a different health organization (e.g., hospital, laboratory) I am electronically notified of my patients interactions with other health organizations (e.g., admissions to hospital) I electronically send prescriptions to pharmacies (e-Prescribing) I electronically send order requests (e.g., for lab, radiology or diagnostic tests) to laboratories 33% 18% 18% 36% 25% 30%* 47%* 20%* 21% 34% 27%* 22% 42% 11% 17% -6% 8% -27% 29% 12% 11%* 16%* 19% 32%* 52%* 34% 15% 7% 9% 26%* 24% 37% 17% 25% -36% -44% 37% -25% -29% 2011 58% 54%* 31% 2012 66%* 47% 36%* % change 14% -13% 16% 2011 67% 57%* 27% France Total 2012 68% 36% 26% % change 1% -37% -4%
20%
22%*
10%
18%
16%
-11%
53%
54%
2%
134
France appears to have experienced a slight decrease in adoption of Healthcare IT and HIE between 2011 and 2012. Connected Health Maturity Index: Total Doctors, 2011-2012
Y Axis
60
2011
2012
France 2011
France 2012
50
Spain Spain US
40
England England
Singapore US
Singapore
30
Canada
20
Canada
10 10 20 30 40 50 60
135
Although doctors in France report many benefits of HIE, such as improved decision-making ability and reduced medical errors since 2011, it appears many hoped-for benefits have dropped-off in the past year. Fewer doctors report reduced service costs, reduced patient wait times and reduced risk of litigation. Moreover, improvements in the ability to see more patients daily and achieve a better work-life balance have not been realized; in fact, they appear to be declining.
France 2012 76%* % Change 9%
71%
71% 60%*
77%*
77%* 42%
8%
8% -30%
45%* 45%*
56%* 43%*
38% 31%
49% 34%
-16% -31%
-13% -21%
136
For the second year, the main barrier to electronic medical records (EMR) and HIE adoption cited by doctors is cost. In France, doctors ranked the difficulty of using EMR systems, a lack of technical expertise, and lack of easy access to a computer as growing concerns. Barriers to EMR/HIE Adoption
8-Country Total 2011 Ranked 1st Most Important Cost to my organization Concerns about privacy and security of patient data Concern about loss of productivity/too time consuming to input data The system is too difficult to use IT systems that can't 'talk' to each other Lack of technical expertise to manage implementation Lack of easy access to a computer Low IT literacy/lack of training among clinicians and staff 14% 13% 10% 5% 11% 4% 2% 5% 2011 2012 Ranked 1st Most Important 24% 11% 10% 8% 8% 6% 5% 5% 2012 2011 Ranked 1st Most Important 10% 11% France Total 2011 2012 Ranked 1st Most Important 16% 10% 2012
Rank
Rank
Rank
Rank
1 2 4 6 3 7 9 6
1 2 3 4 4 5 6 6
4 3
1 3
14%
5% 13%
1
7 2
16%
11% 3%
1
2 8
4%
1% 8%
8
10 5
8%
6% 7%
4
6 5
Many doctors in France state that patients should be able to update information in their EMR such as demographic information, both personal and family medical history, and allergic episodes. Doctors in France are more enthusiastic about patients updating lab test results than doctors in the other countries.
Patient Allowed Access to Electronic Medical Record
8-Country Total
8-Country Total France Total 29% 44% 46% 50% 47% 48% 45% 55% 55% 65% 19% 25% 19% 21% 34% 29% 56% 47% 50% 54% 63% 53% 53% 70% 65% 60% All information
No Access 14% Limited Access 62% Full Access 24%
Lab test results Change in symptoms New symptoms New medications
45% 23% 23% 21% 20% 19% 18% 17% 15% 34% 32% 28% 33% 33% 37% 28% 29%
25%
17% 29% 12% 25% 16% 31% 12% 35% 10% 20% 9% 26% 14% 26% Some information

France Total
Allergic episodes
Limited access 68%
138
Research Results
Globally, as well as in France, most physicians use EMR (91% and 92%, respectively). In both cases, more than half use it in their own practice. Location of EMR Use

Yes (NET): 95% 93% 93% 92% 91%

87% 83% 82% 76%
73%
68% 59% 39% 27%
65%
63%
67% 60% 46% 34% 27% 37% 37% 58% 51% 43% 47%
Spain
Germany
US
France
Global Total
Singapore
Australia
England
Canada
(n=500)
(n=500)
(n=500)
(n=500)
(n=3,700)
(n=200)
(n=500)
(n=500)
(n=500)
140
Globally, the number of physicians electronically entering patient notes routinely has increased since last year (up 14%). Routine use in France remained virtually unchanged. I electronically enter patient notes either during or after consultations
4%
1%
1%
14%
14%
19%
27%
22%
Use Routinely
41% 58% 58% 56% 66% 64% 54% 64% 7% 6% 19% 6% 4% 8% 6% 7% 5% 11% 5% 3% 4% 11% 9% 3% 9% 5% 5% 9% 4% 9% 8% 9% 7% 7% 10% 4% 5% 13% 9% 9% 5% 10% 19% 5% 12% 10% 8% 4% 9% 26% 5% 17% 16% 8% 5% 7% 2011 2012 2011 2012 18% 7% 15% 15% 12% 2011 2012 6% 19% 36% 29% 8% 7% 52% 67% 68% 36% 44%
Use Sometimes
78%
74% 77%
72% 73%
Use Rarely
6% 10%
18% 7% 12% 10% 7% 2011 2012
Interested in Using
23%
7% 2% 9% 4%
9%
2011 2012
2011 2012
2011 2012
2011 2012
2011 2012
US
Germany
Spain
France
Global Total
Australia
England
Singapore
Canada
(n=500)
(n=500)
(n=500)
(n=500)
(n=3,700)
(n=500)
(n=500)
(n=200)
(n=500)
141
Globally, the number of physicians who routinely access clinical data about patients seen by different health organizations has increased by 42%. France increased its routine use by 17%. I have electronic access to clinical data about a patient who has been seen by a different health organization (e.g., hospital, laboratory)
32%
53%
42%
32%
42%
62%
77%
17%
32% 41% 49% 69% 19% 17% 15% 5% 15% 6% 13% 24% 5% 10% 6% 3% 8% 3% 2011 2012 2011 2012 6% 29% 22% 24% 22% 5% 2011 2012 17% 7% 10% 15% 54% 49%
33% 47%
34% 45%
31% 44%
26% 42%
22% 39% 12%
Use Routinely
29% 34%
Use Sometimes
13% 10% 14% 7% 5%
15% 15% 7% 15% 18% 7% 15% 6% 34% 24% 35% 5% 19% 17% 6% 8% 38% 26% 43% 28% 15% 16% 2011 2012 6% 17% 6% 43% 28% 8%
Use Rarely
7%
37% 37%
24%
11% 8% 2011 2012 8% 9% 7% 10% 7% 2011 2012 14% 10%
4%
2011 2012
2011 2012
2011 2012
Spain
England
Singapore
Global Total
US
Canada
Australia
Germany
France
(n=500)
(n=500)
(n=200)
(n=3,700)
(n=500)
(n=500)
(n=500)
(n=500)
(n=500)
142
Globally, the number of physicians who routinely e-Prescribe increased by 17% since 2011. However, France decreased routine e-Prescribing usage by 36%, and has one of the lowest proportions of physicians routinely e-Prescribing (7%). I electronically send prescriptions to pharmacies (e-Prescribing)
36%
32%
17%
0%
0%
-36%
20%
5% 5% 9% 6% 5% 7%
-43%
4% 5% 8%
25% 36% 49% 65% 17% 13% 7% 11% 21% 5% 12% 10% 7% 2011 2012 8% 16% 43% 14% 8% 39% 49% 6% 10% 6% 33%
18% 21%
8% 10%
12% 12% 8% 9%
8% 6%
8% 5%
11%
10%
7% 9% 11%
7% 5% 11%
Use Routinely
9% 10%
8% 8%
11% 7%
12%
Use Sometimes
47%
7%
52% 55% 57% 59% 43% 57% 58%
44%
Use Rarely
43% 43%
42%
Interested in Using
25%
30% 33% 36% 24% 24%
20%
25%
16% 15% 7% 2011 2012 2011 2012
21% 20%
17% 17%
20% 18%
2011 2012
2011 2012
2011 2012
2011 2012
2011 2012
2011 2012
US
Singapore
Spain
Global Total
England
Canada
France
Australia
Germany
(n=500)
(n=200)
(n=500)
(n=3,700)
(n=500)
(n=500)
(n=500)
(n=500)
(n=500)
143
Although globally, there is a 16% increase in the number of physicians reporting they routinely receive electronic alerts/reminders while seeing patients, France experienced a 4% decrease. I receive electronic alerts/reminders while I am seeing my patients (e.g., prompts regarding contraindications or preventative care)
32%
10%
3%
16%
13%
52%
-4%
12%
21% 34% 45% 46% 45% 40% 44% 37% 38% 31% 36% 31% 35% 15% 32%
27% 26%
17% 19% 7% 11%
Use Routinely
13% 13% 14% 9% 13% 11% 5% 8% 31% 29% 24% 22% 14% 15% 27% 22% 31% 23% 14% 13% 2011 2012 19% 11% 2011 2012 6% 16% 13% 7% 8% 16% 20% 13% 15% 9% 9% 11% 33% 27% 20% 20% 17% 16% 20% 10% 14% 33% 27% 20% 20% 14% 20% 9% 11%
11% 8%
Use Sometimes
Use Rarely
47% 45%
7%
9%
9% 35% 30%
Interested in Using
10%
9%
13% 13% 2011 2012
7%
8%
12%
18% 17%
2011 2012
2011 2012
2011 2012
2011 2012
2011 2012
2011 2012
England
US
Australia
Spain
Global Total
Singapore
Germany
France
Canada
(n=500)
(n=500)
(n=500)
(n=500)
(n=3,700)
(n=200)
(n=500)
(n=500)
(n=500)
144
Globally, as well as in France, the majority of physicians believe that patients should have at least limited access to their electronic personal health records (85% and 89%, respectively). Access Patient Should Have to Electronic Personal Health Record
34%
31%
30%
29%
24%
22%
21%
18%
12% Full access
60%
65%
63%
57%
61%
68%
No access
14%
Canada
14%
Global Total
13% Spain
11%
France
(n=500)
(n=500)
(n=200)
(n=500)
(n=3,700)
(n=500)
(n=500)
(n=500)
(n=500)
145
French doctors opinions about the extent to which patients should be able to update all demographic information (60%) is in line with doctors globally (65%). Demographic Information
95% 90% 89% 88% 88% 87% 86% 86% 80%
41% 55% 79% 73% 65% 62% 63% 60%
57%
All information
Some information

20%
Germany
(n=476)
(n=430)
(n=3,200)
(n=184)
(n=473)
(n=429)
(n=444)
(n=439)
(n=325)
146
More than half of physicians, both globally and in France, are in favor of allowing patients to update all information about their family medical history in their health record (65% and 55%, respectively). Family Medical History
91%
91%
88%
85%
84%
84%
81%
78%
72%
37%
54% 65% 67% 55% 54% 47% 49%
43%
All information
Some information
44% 37% 29% 29% 37%
29%
21%
31%
26%

22% 28%
9% France
9% Singapore
12% US
15%
Global Total
16% Canada
16% England
19%
Germany
Australia
Spain
(n=444)
(n=184)
(n=476)
(n=3,200)
(n=430)
(n=473)
(n=325)
(n=429)
(n=439)
147
Physicians in France (70%) are most in favor of allowing patients to update all information about allergic episodes in their health record. Allergic Episodes
90%
85%
83%
83%
81%
80%
79%
77%
74%
44%
57%
70%
55%
62%
54%
49%
52%
48%
All information
Some information
Germany
Singapore
Canada
England
Australia
(n=444)
(n=476)
(n=3,200)
(n=439)
(n=325)
(n=184)
(n=430)
(n=473)
(n=429)
148
Globally, three-quarters of physicians are in favor of allowing patients to update at least some information about changes in symptoms in their health record. In France eight out of ten physicians feel that patients should be able to update at least some of this information. Change in Symptoms
86%
81%
81%
77%
75%
72%
72%
71%
71%
33% 43% 47% 50% 44%
39%
40%
42% 43% 34%
33%
32%
35% 26%
34%
31%
14% Singapore
19%
19%
23%
25%
28%
28%
29%
29%
France
US
Global Total
Germany
Australia
England
Canada
Spain
(n=184)
(n=444)
(n=476)
(n=3,200)
(n=325)
(n=429)
(n=473)
(n=430)
(n=439)
149
Both globally and in France, eight out of ten physicians are in favor of allowing patients to update at least some information about medication side effects in their health record. Medication Side Effects
84%
82%
82%
81%
80%
79%
78%
78%
72%
53%
47%
50%
48%
53%
48%
41%
39%
40% All information
31%
35%
32%
33%
27%
31%
37%
39%
32%
16% France
18% Singapore
18% US
19%
20%
21%
22%
22%
28%
Global Total
Spain
England
Canada
Germany
Australia
(n=444)
(n=184)
(n=476)
(n=3,200)
(n=439)
(n=473)
(n=430)
(n=325)
(n=429)
150
Globally, eight out of ten physicians are in favor of allowing patients to update at least some selfmeasured metrics information in their health record. In France almost nine out of ten physicians feel that patients should be able to update at least some of this information Self-Measured Metrics
93%
88%
83%
82%
81%
79%
78%
77%
75%
44% 54% 53%
45%
45%
48%
41%
43%
36% All information
39% 39% 35%
37%
36%
32%
37%
39% 35%
7% Singapore
12% France
17% Germany
18% Global Total
19%
21%
22%
23%
25%
US
Spain
England
Canada
Australia
(n=184)
(n=444)
(n=325)
(n=3,200)
(n=476)
(n=439)
(n=473)
(n=430)
(n=429)
151
The majority of physicians feel that the quality of patient care throughout the healthcare system has improved due to the use of EMR (61%). French physicians opinions are comparable (63%). Change in Quality of Patient Care
It has improved
65%
87% 84%
63%
63%
61%
58%
56%
53%
28% 27% 10% 2%

Singapore
It has gotten worse
31%
33%
30%
36%
40% 19%
9% 7%
Spain
7%
England
6%
Canada
4%
France
10%
Global Total
6%
Australia
4%
Germany US
(n=200)
(n=500)
(n=500)
(n=500)
(n=500)
(n=3,700)
(n=500)
(n=500)
(n=500)
152
Whereas globally, seven out of ten physicians have read online forums in the past six months, in France half of physicians have done so. Physicians in France, Australia, and Canada are least likely to have commented and/or posted to an online article or forum. Internet Usage in the Past Six Months
Global Total
(n=3,700)
Australia
(n=500)
Canada
(n=500)
England
(n=500)
France
(n=500)
Germany
(n=500)
Singapore
(n=200)
Spain
(n=500)
US
(n=500)
Read online forums
71%
70%
76%
77%
51%
61%
74%
66%
82%
52%
48%
53%
58%
52%
45%
50%
49%
57%
29%
17%
17%
28%
17%
45%
35%
33%
24%
19%
12%
15%
18%
25%
12%
29%
35%
17%
12%
5%
8%
15%
7%
10%
28%
24%
10%
12%
19%
13%
10%
19%
14%
11%
12%
9%
153
Doctors Survey: Spain Country Profile
Research Results
Highlights of Spain and 8-Country Findings
Key Spain Findings - Summary
Key study findings for Spain physicians revealed that over the last two years, doctors in Spain had the highest adoption of Healthcare IT and HIE.
Doctors in Spain especially, are embracing the use of these technologies, despite the fact that many agree the use of HIE, specifically, does not reduce organizational cost as anticipated.
Nevertheless, doctors state they have realized important HIE benefits such as improved decision-making and the reduction of medical errors.
Additionally, doctors in Spain are embracing the Internet. Two-thirds read online forums, and doctors in Spain are the most apt to access news from an RSS feed. 1) cost is one of the main barriers to electronic medical record (EMR) adoption, and
2) patients should have at least some access to and be able to update elements of their EMR.
156
Spain Physician Demographics

8-Country Total
Spain
(n=500) Organization Status
8-Country Total
(n=3,700)
Spain
(n=500)
73% 27%
72% 28%
54% 7% 39% 172.1
85% 2% 13% 280.1
2% 24% 34% 30% 10%
1% 20% 34% 38% 7%
62% 15% 13% 8% 1% 1% 1% (n=2,604) 28% 44% 28%
53% 13% 19% 12% 2% 0% 0% (n=327) 34% 36% 30%

50% 50% 18.3 79%
50% 50% 20.5 82%
66% 20% 14%
81% 10% 8%
157
Doctors in Spain and abroad increasingly electronically access clinical data about a patient who has been seen by a different health organization. However, use of electronic tools to reduce administrative burden and communicating electronically with clinicians in other organizations have not been as robust in Spain as in the prior year.
8-Country Total Healthcare IT I electronically enter patient notes either during or after consultations My organization uses electronic tools to reduce the administrative burden for delivering health care (e.g., e-scheduling or e-billing) I receive electronic alerts/reminders while I am seeing my patients (e.g., prompts regarding contraindications or preventative care) I use computerized clinical decision support systems to help make diagnostic and treatment decisions while I am seeing my patients (e.g., real-time access to evidence-based practice guidelines) HIE I have electronic access to clinical data about a patient who has been seen by a different health organization (e.g., hospital, laboratory) I am electronically notified of my patients interactions with other health organizations (e.g., admissions to hospital) I electronically send prescriptions to pharmacies (e-Prescribing) I electronically send order requests (e.g., for lab, radiology or diagnostic tests) to laboratories 33% 18% 18% 36% 25% 30%* 47%* 20%* 21% 34% 27%* 22% 42% 11% 17% -6% 8% -27% 49% 29% 25% 59% 47% 44%* 64% 69%* 32% 33%* 61% 55%* 30% 63% 41% 10% 32% 3% 17% -32% -2% 2011 58% 54%* 31% 2012 66%* 47% 36%* % change 14% -13% 16% 2011 72% 65%* 37% Spain Total 2012 73% 47% 38% % change 1% -28% 3%
20%
22%*
10%
29%
36%*
24%
53%
54%
2%
158
In 2011, doctors in Spain had the highest adoption of Healthcare IT and HIE. This trend continued in 2012. While the US and Singapore lagged a bit behind Spain in 2011, it appears that they are catching up. Connected Health Maturity Index: Total Doctors, 2011-2012
Y Axis
60
2011
2012
Spain 2011
Spain 2012
50
Spain Spain US
40
England England
Singapore US
Singapore
30
Canada
20
Canada
10 10 20 30 40 50 60
159
In Spain (as well as in the other seven countries), routine use of HIE is on the rise. At the same time, the perception that HIE reduces costs is going down. In 2012 doctors were less likely to report that HIE reduces costs to their organization or service compared to 2011.

80% 70% 60% 52% 50% 40% 30% 20% 10% 0% 2011 2012 19% 21% Reduces organizational Cost (Spain) 38% 43% 41% Reduces Organizational Cost (8 country total) 70% Routine HIE Users* (8 country total)
57%
Routine HIE Users* (Spain)
160
Although doctors in Spain report many benefits of HIE, such as improved decision-making ability and reduced medical errors, it appears many hoped-for economic benefits have dropped-off in the past year. Fewer doctors report reduced service costs, reduced patient wait times and reduced risk of litigation. Moreover, improvements in the ability to see more patients daily and achieve a better work-life balance have not been realized; in fact, they appear to be declining.
Spain 2012 81% % Change 4%
80%
80% 79%*
79%
75% 66%
-1%
-6% -16%
59%* 51%*
66%* 52%*
44% 35%
40% 31%
-25% -31%
-39% -40%
161
For the second year, doctors in Spain indicate that the main barrier to electronic medical records (EMR) and HIE adoption is concerns about privacy and security of patient information. 2012 saw an increase among doctors in Spain which ranked cost, difficulty in using EMR systems, and lack of easy access to a computer as growing concerns.

8-Country Total
2011 2011 2012 2012 2011
Spain Total
2011 2012 2012

Rank

24% 11% 10% 8% 8% 6% 5% 5%
Rank

7% 11% 8% 4% 11% 6% 3% 5%
Rank

12% 16% 8% 9% 8% 4% 10% 5%
Rank
1 2 4 6 3 7 9 6
1 2 3 4 4 5 6 6
4 1 3 7 1 5 8 6
2 1 5 4 5 7 3 6
Many doctors in Spain state that patients should be able to update information in their EMR such as demographic information and allergic episodes. Doctors in Spain, as well as those in the other study countries, however, are less enthusiastic about patients updating lab test results. Patient Allowed Access to Electronic Medical Record
8-Country Total
8-Country Total Spain Total 29% 44% 46% 50% 47% 48% 45% 55% 55% 65%
45% 23% 23% 21% 20% 19% 18% 17% 15% 34% 32% 28% 33% 33% 37% 28% 29%
25%
34%
29% 26% 25% 30%
29%
26% 28% 24% 32%
38%
45% 46% 51% 38% 53% 48% 63% 43% 57%

20% 27% 20% 32%
Spain Total
Allergic episodes
17% 20% 28% 29%
Limited access 65%
14% 29% Some information
All information
163
Research Results
Globally, as well as in Spain, most physicians use EMR (91% and 95%, respectively). Globally, six out of ten doctors use it in their own practice, whereas in Spain almost three-quarters use it in their own practice. Location of EMR Use

Yes (NET): 95% 93% 93% 92% 91%

87% 83% 82% 76%
73%
68% 59% 39% 27%
65%
63%
67% 60% 46% 34% 27% 37% 37% 58% 51% 43% 47%
Spain
Germany
US
France
Global Total
Singapore
Australia
England
Canada
(n=500)
(n=500)
(n=500)
(n=500)
(n=3,700)
(n=200)
(n=500)
(n=500)
(n=500)
165
Globally, the number of physicians electronically entering patient notes routinely has increased since last year (up 14%). Levels of routine use in Spain remain consistently high (almost threequarters of doctors in 2011 and 2012). I electronically enter patient notes either during or after consultations
4%
1%
1%
14%
14%
19%
27%
22%
Use Routinely
41% 58% 58% 56% 66% 64% 54% 64% 7% 6% 19% 6% 4% 8% 6% 7% 5% 11% 5% 3% 4% 11% 9% 3% 9% 5% 5% 9% 4% 9% 8% 9% 7% 7% 10% 4% 5% 13% 9% 9% 5% 10% 19% 5% 12% 10% 8% 4% 9% 26% 5% 17% 16% 8% 5% 7% 2011 2012 2011 2012 18% 7% 15% 15% 12% 2011 2012 6% 19% 36% 29% 8% 7% 52% 67% 68% 36% 44%
Use Sometimes
78%
74% 77%
72% 73%
Use Rarely
6% 10%
18% 7% 12% 10% 7% 2011 2012
Interested in Using
23%
7% 2% 9% 4%
9%
2011 2012
2011 2012
2011 2012
2011 2012
2011 2012
US
Germany
Spain
France
Global Total
Australia
England
Singapore
Canada
(n=500)
(n=500)
(n=500)
(n=500)
(n=3,700)
(n=500)
(n=500)
(n=200)
(n=500)
166
Globally, the number of physicians who routinely access clinical data about patients seen by different health organizations has increased by 42%. Spain increased its routine use by 41%, and is the country most likely to routinely access this data. I have electronic access to clinical data about a patient who has been seen by a different health organization (e.g., hospital, laboratory)
32%
53%
42%
32%
42%
62%
77%
17%
32% 41% 49% 69% 19% 17% 15% 5% 15% 6% 13% 24% 5% 10% 6% 3% 8% 3% 2011 2012 2011 2012 6% 29% 22% 24% 22% 5% 2011 2012 17% 7% 10% 15% 54% 49%
33% 47%
34% 45%
31% 44%
26% 42%
22% 39% 12%
Use Routinely
29% 34%
Use Sometimes
13% 10% 14% 7% 5%
15% 15% 7% 15% 18% 7% 15% 6% 34% 24% 35% 5% 19% 17% 6% 8% 38% 26% 43% 28% 15% 16% 2011 2012 6% 17% 6% 43% 28% 8%
Use Rarely
7%
37% 37%
24%
11% 8% 2011 2012 8% 9% 7% 10% 7% 2011 2012 14% 10%
4%
2011 2012
2011 2012
2011 2012
Spain
England
Singapore
Global Total
US
Canada
Australia
Germany
France
(n=500)
(n=500)
(n=200)
(n=3,700)
(n=500)
(n=500)
(n=500)
(n=500)
(n=500)
167
Globally, the number of physicians who routinely e-Prescribe increased by 17% since last year. Spain increased routine e-Prescribing usage by 32%, but trails the US and Singapore in the proportion of physicians routinely e-Prescribing. I electronically send prescriptions to pharmacies (e-Prescribing)
36%
32%
17%
0%
0%
-36%
20%
5% 5% 9% 6% 5% 7%
-43%
4% 5% 8%
25% 36% 49% 65% 17% 13% 7% 11% 21% 5% 12% 10% 7% 2011 2012 8% 16% 43% 14% 8% 39% 49% 6% 10% 6% 33%
18% 21%
8% 10%
12% 12% 8% 9%
8% 6%
8% 5%
11%
10%
7% 9% 11%
7% 5% 11%
Use Routinely
9% 10%
8% 8%
11% 7%
12%
Use Sometimes
47%
7%
52% 55% 57% 59% 43% 57% 58%
44%
Use Rarely
43% 43%
42%
Interested in Using
25%
30% 33% 36% 24% 24%
20%
25%
16% 15% 7% 2011 2012 2011 2012
21% 20%
17% 17%
20% 18%
2011 2012
2011 2012
2011 2012
2011 2012
2011 2012
2011 2012
US
Singapore
Spain
Global Total
England
Canada
France
Australia
Germany
(n=500)
(n=200)
(n=500)
(n=3,700)
(n=500)
(n=500)
(n=500)
(n=500)
(n=500)
168
Globally there is a 16% increase in the number of physicians reporting they routinely receive electronic alerts/reminders while seeing patients; in Spain however the levels remains consistent with 2011. I receive electronic alerts/reminders while I am seeing my patients (e.g., prompts regarding contraindications or preventative care)
32%
10%
3%
16%
13%
52%
-4%
12%
21% 34% 45% 46% 45% 40% 44% 37% 38% 31% 36% 31% 35% 15% 32%
27% 26%
17% 19% 7% 11%
Use Routinely
13% 13% 14% 9% 13% 11% 5% 8% 31% 29% 24% 22% 14% 15% 27% 22% 31% 23% 14% 13% 2011 2012 19% 11% 2011 2012 6% 16% 13% 7% 8% 16% 20% 13% 15% 9% 9% 11% 33% 27% 20% 20% 17% 16% 20% 10% 14% 33% 27% 20% 20% 14% 20% 9% 11%
11% 8%
Use Sometimes
Use Rarely
47% 45%
7%
9%
9% 35% 30%
Interested in Using
10%
9%
13% 13% 2011 2012
7%
8%
12%
18% 17%
2011 2012
2011 2012
2011 2012
2011 2012
2011 2012
2011 2012
England
US
Australia
Spain
Global Total
Singapore
Germany
France
Canada
(n=500)
(n=500)
(n=500)
(n=500)
(n=3,700)
(n=200)
(n=500)
(n=500)
(n=500)
169
Globally as well as in Spain, the majority of physicians believe that patients should have at least limited access to their electronic personal health records (85% and 87%, respectively). Access Patient Should Have to Electronic Personal Health Record
34%
31%
30%
29%
24%
22%
21%
18%
12% Full access
60%
65%
63%
57%
61%
68%
No access
14%
Canada
14%
Global Total
13% Spain
11%
France
(n=500)
(n=500)
(n=200)
(n=500)
(n=3,700)
(n=500)
(n=500)
(n=500)
(n=500)
170
Second to Germany, physicians in Spain are least in favor of patients being able to update all demographic information in their personal health record (57%). Demographic Information
95% 90% 89% 88% 88% 87% 86% 86% 80%
41% 55% 79% 73% 65% 62% 63% 60%
57%
All information
Some information

20%
Germany
(n=476)
(n=430)
(n=3,200)
(n=184)
(n=473)
(n=429)
(n=444)
(n=439)
(n=325)
171
Physicians in Spain are least in favor of allowing patients to update at least some information about their family medical history in their health record (72%). Family Medical History
91%
91%
88%
85%
84%
84%
81%
78%
72%
37%
54% 65% 67% 55% 54% 47% 49%
43%
All information
Some information
44% 37% 29% 29% 37%
29%
21%
31%
26%

22% 28%
9% France
9% Singapore
12% US
15%
Global Total
16% Canada
16% England
19%
Germany
Australia
Spain
(n=444)
(n=184)
(n=476)
(n=3,200)
(n=430)
(n=473)
(n=325)
(n=429)
(n=439)
172
More than half of physicians, both globally and in Spain (55% and 62%, respectively), feel that patients should be able to update all information about allergic episodes in their health record. Allergic Episodes
90%
85%
83%
83%
81%
80%
79%
77%
74%
44%
57%
70%
55%
62%
54%
49%
52%
48%
All information
Some information
Germany
Singapore
Canada
England
Australia
(n=444)
(n=476)
(n=3,200)
(n=439)
(n=325)
(n=184)
(n=430)
(n=473)
(n=429)
173
Globally, three-quarters of physicians are in favor of allowing patients to update at least some information about changes in symptoms in their health record (77%). In Spain seven out of ten physicians feel that patients should be able to update at least some of this information. Change in Symptoms
86%
81%
81%
77%
75%
72%
72%
71%
71%
33% 43% 47% 50% 44%
39%
40%
42% 43% 34%
33%
32%
35% 26%
34%
31%
14% Singapore
19%
19%
23%
25%
28%
28%
29%
29%
France
US
Global Total
Germany
Australia
England
Canada
Spain
(n=184)
(n=444)
(n=476)
(n=3,200)
(n=325)
(n=429)
(n=473)
(n=430)
(n=439)
174
Both globally and in Spain, eight out of ten physicians are in favor of allowing patients to update at least some information about medication side effects in their health record. Medication Side Effects
84%
82%
82%
81%
80%
79%
78%
78%
72%
53%
47%
50%
48%
53%
48%
41%
39%
40% All information
31%
35%
32%
33%
27%
31%
37%
39%
32%
16% France
18% Singapore
18% US
19%
20%
21%
22%
22%
28%
Global Total
Spain
England
Canada
Germany
Australia
(n=444)
(n=184)
(n=476)
(n=3,200)
(n=439)
(n=473)
(n=430)
(n=325)
(n=429)
175
Both globally and in Spain, eight out of ten physicians are in favor of allowing patients to update at least some self-measured metrics information in their health record. Self-Measured Metrics
93%
88%
83%
82%
81%
79%
78%
77%
75%
44% 54% 53%
45%
45%
48%
41%
43%
36% All information
39% 39% 35%
37%
36%
32%
37%
39% 35%
7% Singapore
12% France
17% Germany
18% Global Total
19%
21%
22%
23%
25%
US
Spain
England
Canada
Australia
(n=184)
(n=444)
(n=325)
(n=3,200)
(n=476)
(n=439)
(n=473)
(n=430)
(n=429)
176
The majority of physicians feel that the quality of patient care throughout the healthcare system has improved due to the use of EMR (61%). Physicians in Singapore and Spain are most likely to feel this way. (87% and 84%, respectively). Change in Quality of Patient Care
It has improved
65%
87% 84%
63%
63%
61%
58%
56%
53%
28% 27% 10% 2%

Singapore
It has gotten worse
31%
33%
30%
36%
40% 19%
9% 7%
Spain
7%
England
6%
Canada
4%
France
10%
Global Total
6%
Australia
4%
Germany US
(n=200)
(n=500)
(n=500)
(n=500)
(n=500)
(n=3,700)
(n=500)
(n=500)
(n=500)
177
Two-thirds of physicians in Spain have read online forums and half have viewed an online video in the past six months. Physicians in Spain are the most apt to access news from an RSS feed. Internet Usage in the Past Six Months
Global Total
(n=3,700)
Australia
(n=500)
Canada
(n=500)
England
(n=500)
France
(n=500)
Germany
(n=500)
Singapore
(n=200)
Spain
(n=500)
US
(n=500)
Read online forums
71%
70%
76%
77%
51%
61%
74%
66%
82%
52%
48%
53%
58%
52%
45%
50%
49%
57%
29%
17%
17%
28%
17%
45%
35%
33%
24%
19%
12%
15%
18%
25%
12%
29%
35%
17%
12%
5%
8%
15%
7%
10%
28%
24%
10%
12%
19%
13%
10%
19%
14%
11%
12%
9%
178
Doctors Survey: US Country Profile
Research Results
Highlights of US and 8-Country Findings
Key US Findings - Summary
Key study findings for US physicians revealed that over the last two years, doctors use of healthcare IT and HIE is rising.
US doctors especially, are embracing the use of these technologies, despite the fact that many agree the use of HIE, specifically, does not reduce organizational cost as anticipated.
Nevertheless, doctors state they think they have achieved some important HIE benefits such as improved decision-making and the reduction of medical errors.
Additionally, US doctors are embracing the Internet as they are the most avid readers of online forums and are more apt to view online videos. 1) cost is the main barrier to electronic medical record (EMR) adoption, and 2) patients should have at least some access to and be able to update elements of their EMR.
Moreover, doctors uniformly agree on two key issues:

181
US Physician Demographics
Global Total
(n=3,700)
US
(n=500)
Global Total
(n=3,700)
US
(n=500)
Gender Male Female Age Under 30 30-39 40-49 50-59 60+ Physician Type Primary Care/General Practice/Family Physician Secondary Care/Specialist Average # of Years Practicing Medicine Average Time Spent Face-to-Face with Patients Location of Primary Work Place Urban/City Suburban/Next to a city Small town/Rural
Organization Status 73% 27% 75% 25% Public Private not-for-profit/charitable Private for profit 2% 24% 34% 30% 10% 2% 36% 32% 20% 10% Average # of Physicians in Organization Primary Work Setting Mostly office - or clinic-based 62% 15% 13% 8% 1% 1% 1% 63% 11% 12% 12% 1% 0% 1% 54% 7% 39% 172.1 16% 31% 53% 193.6

50% 50% 18.3 79%
50% 50% 13.7 85%
Mostly long-term care facility-based Mostly hospice-based Other Practice Size Solo practice
28% 44% 28%
11% 53% 36%
66% 20% 14%
46% 41% 13%
182
Doctors in the US and abroad increasingly use healthcare IT functions such as patient information recordkeeping, alerts and reminders, whereas the use of electronic tools such as e-billing and e-scheduling to reduce administrative burden have not been as robust as in the prior year.
8-Country Total Healthcare IT I electronically enter patient notes either during or after consultations My organization uses electronic tools to reduce the administrative burden for delivering health care (e.g., e-scheduling or e-billing) I receive electronic alerts/reminders while I am seeing my patients (e.g., prompts regarding contraindications or preventative care) I use computerized clinical decision support systems to help make diagnostic and treatment decisions while I am seeing my patients (e.g., real-time access to evidence-based practice guidelines) HIE I have electronic access to clinical data about a patient who has been seen by a different health organization (e.g., hospital, laboratory) I am electronically notified of my patients interactions with other health organizations (e.g., admissions to hospital) I electronically send prescriptions to pharmacies (e-Prescribing) I electronically send order requests (e.g., for lab, radiology or diagnostic tests) to laboratories 33% 18% 18% 36% 25% 30% 47%* 20%* 21% 34% 27%* 22%* 42% 11% 17% -6% 8% -27% 34% 19% 49% 47% 27% 25% 45%* 19% 65%* 57%* 32% 23% 32% 0% 33% 21% 19% -8% 2011 58% 54% 31% 2012 66%* 47%* 36%* % change 14% -13% 16% 2011 58% 61% 34% US Total 2012 78%* 55% 45%* % change 34% -10% 32%
20%
22%*
10%
21%
24%
14%
53%
54%
2%
50%
62%*
24%
183
In 2011 doctors in Spain had the highest adoption of Healthcare IT and HIE. This trend continued in 2012. Thus, it appears that while the US and Singapore lagged behind Spain in 2011, they are catching up. Connected Health Maturity Index: Total Doctors, 2011-2012
Y Axis
60
2011
2012
US 2011
US 2012
50
Spain Spain US
40
England England
Singapore US
Singapore
30
Canada
20
Canada
10 10 20 30 40 50 60
184
While doctors in the United States report many benefits of HIE, such as improved decision-making ability and reduced medical errors since 2011, it appears many hoped-for economic benefits have dropped-off in the past year. Fewer doctors believed reduced service costs, reduced patient wait times and reduced risk of litigation. Moreover, improvements in the ability to see more patients daily and achieve a better work-life balance were realized; in fact, the level of perceived benefits in these areas appears to be declining.
8-Country Total
2011
Improved diagnostic decisions Improved quality of treatment decisions Reduction in medical errors Reduced costs for my own organization/service Reduced waiting lists/waiting times Increased numbers of patients that can be seen per day Reduced risk of litigation Improved work-life balance
US
2011 56% 58% 68% 45% 39% 34% 49% 39% 2012 65%* 65%* 75%* 38%* 32%* 26%* 34%* 27%* % Change 16% 12% 10% -16% 118% -24% -31% -31%
2012 74%* 74% 76% 47% 38%* 34%* 44%* 34%*
% Change 9% 7% 4% -22% -21% -26% -23% -28%
68% 69% 73% 60% 48% 46% 57% 47%
185
For the second year, all doctors indicate the main barrier to electronic medical records (EMR) and HIE adoption is cost. While issues regarding privacy and security of patient information have remained a concern to doctors internationally, 2012 saw an increase among doctors in the US who ranked this issue as a growing concern. In the US, there is also more concern about ease in using EMR systems, loss of productivity, and the lack of staff training to use these systems.

8-Country Total 2011 Ranked 1st Most Important Cost to my organization Concerns about privacy and security of patient data Concern about loss of productivity/too time consuming to input data The system is too difficult to use IT systems that can't 'talk' to each other Lack of technical expertise to manage implementation Lack of easy access to a computer Low IT literacy/lack of training among clinicians and staff 14% 13% 10% 5% 11% 4% 2% 5% 2011 2012 Ranked 1st Most Important 24% 11% 10% 8% 8% 6% 5% 5% 2012 2011 Ranked 1st Most Important 25% 5% 15% 6% 11% 4% 1% 4% US Total 2011 2012 Ranked 1st Most Important 31% 4% 17% 11% 11% 2% 3% 4% 2012
Rank
Rank
Rank
Rank
1 2 4 6 3 7 9 6
1 2 3 4 4 5 6 6
1 5 2 4 3 6 9 6
1 4 2 3 3 6 5 4
Many doctors in the US (the country most open to patient access) state that patients should be able to update other information such as new medications and personal medical history. Doctors in the US, as well as those in the other study countries, however, are less enthusiastic about patients updating lab test results. Patient Allowed Access to Electronic Medical Record
8-Country Total
8-Country Total US Total 29% 44% 46% 50% 47% 48% 45% 55% 55% 65% 19% 19% 47% 31% 30% 28% 25% 50% 51%
45% 23% 23% 21% 20% 19% 18% 17% 15% 34% 32% 28% 33% 33% 37% 28% 29%
25%
14%
15% 18% 19% 15%
27%
30% 32% 36% 28%
60%
54% 50% 45% 57%

US Total
No Access 4% Full Access 26% Limited Access 70%
Allergic episodes
12% 21%
5%16% Some information
67%
79% All information
187
Research Results
Globally, as well as in the US, most physicians use EMR (91% and 93%, respectively). In both cases, more than half use it in their own practice. Location of EMR Use

Yes (NET): 95% 93% 93% 92% 91%

87% 83% 82% 76%
73%
68% 59% 39% 27%
65%
63%
67% 60% 46% 34% 27% 37% 37% 58% 51% 43% 47%
Spain
Germany
US
France
Global Total
Singapore
Australia
England
Canada
(n=500)
(n=500)
(n=500)
(n=500)
(n=3,700)
(n=200)
(n=500)
(n=500)
(n=500)
189
Globally, the number of physicians electronically entering patient notes routinely has increased since last year (up 14%). The US had the greatest increase of routine use (34%). I electronically enter patient notes either during or after consultations
4%
1%
1%
14%
14%
19%
27%
22%
Use Routinely
41% 58% 58% 56% 66% 64% 54% 64% 7% 6% 19% 6% 4% 8% 6% 7% 5% 11% 5% 3% 4% 11% 9% 3% 9% 5% 5% 9% 4% 9% 8% 9% 7% 7% 10% 4% 5% 13% 9% 9% 5% 10% 19% 5% 12% 10% 8% 4% 9% 26% 5% 17% 16% 8% 5% 7% 2011 2012 2011 2012 18% 7% 15% 15% 12% 2011 2012 6% 19% 36% 29% 8% 7% 52% 67% 68% 36% 44%
Use Sometimes
78%
74% 77%
72% 73%
Use Rarely
6% 10%
18% 7% 12% 10% 7% 2011 2012
Interested in Using
23%
7% 2% 9% 4%
9%
2011 2012
2011 2012
2011 2012
2011 2012
2011 2012
US
Germany
Spain
France
Global Total
Australia
England
Singapore
Canada
(n=500)
(n=500)
(n=500)
(n=500)
(n=3,700)
(n=500)
(n=500)
(n=200)
(n=500)
190
Globally, the number of physicians who routinely access clinical data about patients seen by different health organizations has increased by 42%. The US increased its routine use by 32%. I have electronic access to clinical data about a patient who has been seen by a different health organization (e.g., hospital, laboratory)
32%
53%
42%
32%
42%
62%
77%
17%
32% 41% 49% 69% 19% 17% 15% 5% 15% 6% 13% 24% 5% 10% 6% 3% 8% 3% 2011 2012 2011 2012 6% 29% 22% 24% 22% 5% 2011 2012 17% 7% 10% 15% 54% 49%
33% 47%
34% 45%
31% 44%
26% 42%
22% 39% 12%
Use Routinely
29% 34%
Use Sometimes
13% 10% 14% 7% 5%
15% 15% 7% 15% 18% 7% 15% 6% 34% 24% 35% 5% 19% 17% 6% 8% 38% 26% 43% 28% 15% 16% 2011 2012 6% 17% 6% 43% 28% 8%
Use Rarely
7%
37% 37%
24%
11% 8% 2011 2012 8% 9% 7% 10% 7% 2011 2012 14% 10%
4%
2011 2012
2011 2012
2011 2012
Spain
England
Singapore
Global Total
US
Canada
Australia
Germany
France
(n=500)
(n=500)
(n=200)
(n=3,700)
(n=500)
(n=500)
(n=500)
(n=500)
(n=500)
191
Globally, the number of physicians who routinely e-Prescribe increased by 17% since last year. The US increased routine e-Prescribing usage by 33%, and has the highest proportion of physicians routinely e-Prescribing (65%). I electronically send prescriptions to pharmacies (e-Prescribing)
36%
32%
17%
0%
0%
-36%
20%
5% 5% 9% 6% 5% 7%
-43%
4% 5% 8%
25% 36% 49% 65% 17% 13% 7% 11% 21% 5% 12% 10% 7% 2011 2012 8% 16% 43% 14% 8% 39% 49% 6% 10% 6% 33%
18% 21%
8% 10%
12% 12% 8% 9%
8% 6%
8% 5%
11%
10%
7% 9% 11%
7% 5% 11%
Use Routinely
9% 10%
8% 8%
11% 7%
12%
Use Sometimes
47%
7%
52% 55% 57% 59% 43% 57% 58%
44%
Use Rarely
43% 43%
42%
Interested in Using
25%
30% 33% 36% 24% 24%
20%
25%
16% 15% 7% 2011 2012 2011 2012
21% 20%
17% 17%
20% 18%
2011 2012
2011 2012
2011 2012
2011 2012
2011 2012
2011 2012
US
Singapore
Spain
Global Total
England
Canada
France
Australia
Germany
(n=500)
(n=200)
(n=500)
(n=3,700)
(n=500)
(n=500)
(n=500)
(n=500)
(n=500)
192
While globally, there is a 16% increase in the number of physicians reporting they routinely receive electronic alerts/reminders while seeing patients; in the US there is a 32% increase. I receive electronic alerts/reminders while I am seeing my patients (e.g., prompts regarding contraindications or preventative care)
32%
10%
3%
16%
13%
52%
-4%
12%
21% 34% 45% 46% 45% 40% 44% 37% 38% 31% 36% 31% 35% 15% 32%
27% 26%
17% 19% 7% 11%
Use Routinely
13% 13% 14% 9% 13% 11% 5% 8% 31% 29% 24% 22% 14% 15% 27% 22% 31% 23% 14% 13% 2011 2012 19% 11% 2011 2012 6% 16% 13% 7% 8% 16% 20% 13% 15% 9% 9% 11% 33% 27% 20% 20% 17% 16% 20% 10% 14% 33% 27% 20% 20% 14% 20% 9% 11%
11% 8%
Use Sometimes
Use Rarely
47% 45%
7%
9%
9% 35% 30%
Interested in Using
10%
9%
13% 13% 2011 2012
7%
8%
12%
18% 17%
2011 2012
2011 2012
2011 2012
2011 2012
2011 2012
2011 2012
England
US
Australia
Spain
Global Total
Singapore
Germany
France
Canada
(n=500)
(n=500)
(n=500)
(n=500)
(n=3,700)
(n=200)
(n=500)
(n=500)
(n=500)
193
Globally as well as in the US, the majority of physicians believe that patients should have at least limited access to their electronic personal health records (85% and 96%, respectively). Access Patient Should Have to Electronic Personal Health Record
34%
31%
30%
29%
24%
22%
21%
18%
12% Full access
60%
65%
63%
57%
61%
68%
No access
14%
Canada
14%
Global Total
13% Spain
11%
France
(n=500)
(n=500)
(n=200)
(n=500)
(n=3,700)
(n=500)
(n=500)
(n=500)
(n=500)
194
Physicians in the US are most in favor of patients being able to update all demographic information in their personal health record (79%). Demographic Information
95% 90% 89% 88% 88% 87% 86% 86% 80%
41% 55% 79% 73% 65% 62% 63% 60%
57%
All information
Some information

20%
Germany
(n=476)
(n=430)
(n=3,200)
(n=184)
(n=473)
(n=429)
(n=444)
(n=439)
(n=325)
195
More than half of physicians, both globally and in the US, are in favor of allowing patients to update all information about their family medical history in their health record. Family Medical History
91%
91%
88%
85%
84%
84%
81%
78%
72%
37%
54% 65% 67% 55% 54% 47% 49%
43%
All information
Some information
44% 37% 29% 29% 37%
29%
21%
31%
26%

22% 28%
9% France
9% Singapore
12% US
15%
Global Total
16% Canada
16% England
19%
Germany
Australia
Spain
(n=444)
(n=184)
(n=476)
(n=3,200)
(n=430)
(n=473)
(n=325)
(n=429)
(n=439)
196
More than half of physicians, both globally and in the US, feel that patients should be able to update all information about allergic episodes in their health record. Allergic Episodes
90%
85%
83%
83%
81%
80%
79%
77%
74%
44%
57%
70%
55%
62%
54%
49%
52%
48%
All information
Some information
Germany
Singapore
Canada
England
Australia
(n=444)
(n=476)
(n=3,200)
(n=439)
(n=325)
(n=184)
(n=430)
(n=473)
(n=429)
197
Globally, three-quarters of physicians are in favor of allowing patients to update at least some information about changes in symptoms in their health record. In the US eight out of ten physicians feel that patients should be able to update at least some of this information. Change in Symptoms
86%
81%
81%
77%
75%
72%
72%
71%
71%
33% 43% 47% 50% 44%
39%
40%
42% 43% 34%
33%
32%
35% 26%
34%
31%
14% Singapore
19%
19%
23%
25%
28%
28%
29%
29%
France
US
Global Total
Germany
Australia
England
Canada
Spain
(n=184)
(n=444)
(n=476)
(n=3,200)
(n=325)
(n=429)
(n=473)
(n=430)
(n=439)
198
Both globally and in the US, eight out of ten physicians are in favor of allowing patients to update at least some information about medication side effects in their health record. Medication Side Effects
84%
82%
82%
81%
80%
79%
78%
78%
72%
53%
47%
50%
48%
53%
48%
41%
39%
40% All information
31%
35%
32%
33%
27%
31%
37%
39%
32%
16% France
18% Singapore
18% US
19%
20%
21%
22%
22%
28%
Global Total
Spain
England
Canada
Germany
Australia
(n=444)
(n=184)
(n=476)
(n=3,200)
(n=439)
(n=473)
(n=430)
(n=325)
(n=429)
199
Both globally and in the US, eight out of ten physicians are in favor of allowing patients to update at least some self-measured metrics information in their health record. Self-Measured Metrics
93%
88%
83%
82%
81%
79%
78%
77%
75%
44% 54% 53%
45%
45%
48%
41%
43%
36% All information
39% 39% 35%
37%
36%
32%
37%
39% 35%
7% Singapore
12% France
17% Germany
18% Global Total
19%
21%
22%
23%
25%
US
Spain
England
Canada
Australia
(n=184)
(n=444)
(n=325)
(n=3,200)
(n=476)
(n=439)
(n=473)
(n=430)
(n=429)
200
The majority of physicians feel that the quality of patient care throughout the healthcare system has improved due to the use of EMR. Physicians in the US, however, are least likely to feel this way. Change in Quality of Patient Care
It has improved
65%
87% 84%
63%
63%
61%
58%
56%
53%
28% 27% 10% 2%

Singapore
It has gotten worse
31%
33%
30%
36%
40% 19%
9% 7%
Spain
7%
England
6%
Canada
4%
France
10%
Global Total
6%
Australia
4%
Germany US
(n=200)
(n=500)
(n=500)
(n=500)
(n=500)
(n=3,700)
(n=500)
(n=500)
(n=500)
201
Globally, about three-quarters of physicians have read online forums in the past six months. Physicians in the US are the most avid readers of online forums and are more apt to view online videos. Internet Usage in the Past Six Months
Global Total
(n=3,700)
Australia
(n=500)
Canada
(n=500)
England
(n=500)
France
(n=500)
Germany
(n=500)
Singapore
(n=200)
Spain
(n=500)
US
(n=500)
Read online forums
71%
70%
76%
77%
51%
61%
74%
66%
82%
52%
48%
53%
58%
52%
45%
50%
49%
57%
29%
17%
17%
28%
17%
45%
35%
33%
24%
19%
12%
15%
18%
25%
12%
29%
35%
17%
12%
5%
8%
15%
7%
10%
28%
24%
10%
12%
19%
13%
10%
19%
14%
11%
12%
9%
202
Research Results
Appendix
Representativeness and Weighting

What did we do to ensure balance and a representative sample across regions, specialties, etc.? Regular quota updates ensured that all subsequent mail outs and recruitment contacts were targeted to the relevant demographic sectors in order to maintain a fair and representative split of geographies, settings and specialties. Was the data set weighted? Data for the US were weighted by years in practice by gender, region and specialty to be representative of physicians in the US. Data for all other countries were weighted by age, gender and specialty to be representative of the physician population in each country. Three trended questions** (Q705, Q805 and Q905) that were a carryover from the 2011 physicians study, however, were not weighted.
**NOTE: Q705. How frequently do you use/perform the following functions/activities? Q805. To what extent is the use of electronic medical records and health information exchange (HIE) enabling the following benefits? Q905. Please select the 5 main barriers to the adoption and use of electronic medical record systems and health information exchange in your organization.
204
The Digital Doctor is In
Accenture Eight-Country Survey of Doctors Shows Significant Increase in Healthcare IT Usage
Digital doctors across all eight countries are routinely accessing clinical data about patients seen by different health organizations.
206
The global healthcare IT functionality landscape
207
On the rise: These functions represent the top five increases in routine use of healthcare IT
208
Part of the routine: Top five healthcare IT functions for todays digital doctor
209
Countries are showing increases in connected health maturity across both HIE and EMR.
210
Top five least-used functions
211
Do age and size of practice influence perceptions?
212
Top 10 functions where doctors globally perceive a positive impact of EMR and HIE
213
214
215
216
Todays Digital Doctor: Online, But Not In Touch
218
219

Accenture Doctors Survey - All Country Profiles

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Accenture Doctors Survey - All Country Profiles

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Health Insight Driven Health

Doctors Survey: Country Profiles & Charts

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Method: Data Collection Summary

Number of Completed Interviews (3700 total)* Field Start Date

Nov. 20 Nov. 19 Nov. 19 Nov. 16 Nov. 16

English English French German French

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Health Insight Driven Health

Doctors Survey: Australia Country Profile

Highlights of Australia and 8-Country Findings

Key Australia Findings - Summary

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Australia Physician Demographics

8-Country Total (n=3,700)

Location of Primary Work Place

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Health information exchange (% routine users)

France Australia Germany Germany Australia France

X Axis EMR adoption and use (% routine users)

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HIE Use and Physician Perceived Cost Reduction

Routine HIE Users* (Australia)

Reduces organizational Cost (Australia)

*Reduced Base: Excludes doctors not interested in using Healthcare IT or HIE.

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Australia 2012 71%* % Change 13%

*Significant difference between 2011 and 2012; p<.05

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Barriers to EMR/HIE Adoption

Patient Updateable Information in Electronic Medical Record

Limited Access 62%

Personal medical history

Limited access 65%

Demographic information 11% 24%

Patient should not update

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Highlights of Comparative Country Findings

Use in my own practice

Use in my hospital or clinic

68% 59% 39% 27%

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22% 39% 12%

Interested in Using Not Interested in Using

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Not Interested in Using

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17% 19% 7% 11%

13% 13% 2011 2012

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12% Full access

54% 65% 65% Limited access

34% 6% England 4% US 7% Singapore

16% Australia Germany

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41% 55% 79% 73% 65% 62% 63% 60%

Patient should not update

Global Total Singapore