In a survey of slightly more than 30,000 consumers and 626 physicians, Nielsen found only modest upticks in the use of technology in the healthcare arena, and also highlighted the stubborn tendency of providers to operate in siloes, rather than embrace the model of coordinated care that many health reform advocates are championing.
"This survey is evidence of the failure of American healthcare to provide coordinated, technologically enabled, high-quality healthcare to the majority of people," Robert Pearl, chairman of the Council of Accountable Physician Practices, which sponsored the research, said in a statement.
CAPP is a consortium of medical groups that have embraced a coordinated model of care that brings together specialists of various disciplines in what it bills as a holistic, patient-centric model, a vision that sees the broader and more effective use of health IT as critical.
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At a media event announcing the new research, CAPP Executive Director Laura Fegraus explained that the hallmarks of so-called accountable care organizations include coordination among a patient's team of care providers, an emphasis on prevention and evidence-based medicine, and around-the-clock access to a provider for the patient.
"All of these things are enabled by robust information technology," Fegraus said, "beyond having a computer in the office."
In the latest survey, Nielsen describes patients' electronic engagement with physicians as "increasing but still low," with the proportion of respondents who say they have some type of digital access to their providers hovering between 20 percent and 30 percent. Many of those means of access are rather low-tech, such as email or text reminders for appointments or the ability to submit a medical question through an online channel, with adoption still dragging in part because of the privacy and regulatory restrictions on the flow of sensitive health information. Meanwhile, higher-tech means of delivering care like mobile apps and video consults remain at the margins.
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"We definitely see some progress here," said Jennifer Colamonico, vice president of healthcare insights at Nielsen, referring to the modest uptick in the use of health IT over last year's survey.
At the same time, she highlighted the adoption challenge, noting that many patients in the survey said that their care providers offer technology such as online appointment scheduling or text or email reminders, but that they choose not to use them.
"It's not just a matter of having the technology, but it's actually an issue of using it. It's the sort of the old adage of 'if you build it they will come' may or may not apply in healthcare technology." Colamonico said. "Many people are not using the technology that they actually have access to, which creates a different set of barriers to solve."
The Nielsen report also highlights the limitations of one of the bedrock components of health IT: the electronic medical record (EMR). From the outset, the push for broader use of EMRs has been slowed by challenges of interoperability -- the extent to which one record can communicate with another.
But thanks in part to significant federal funding incentives, adoption of EMRs has risen sharply in recent years, though that only tells part of the story, according to Fegraus, who points out that all EMRs do not deliver the same value.
"We can track if a healthcare organization has an electronic medical record," she said. "What we haven't been so good at tracking yet is what does that mean for the patient Do they have to repeat their medical history every time they see a new provider Do they receive contact with their healthcare system at any other point in time except when they're in the room with their own physician"
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In the Nielsen poll, just 49 percent of respondents say that their doctors are able to share health information and know their medical history ahead of an appointment, a modest increase of three percentage points from last year.
Pearl, who in addition to chairing CAPP is also CEO of the Permanente Medical Group and the Mid-Atlantic Permanente Medical Group, sees three distinct phases in the evolution of the EMR. First is the basic adoption of a system at a hospital or physician's office, what could simply be a digital version of the paper file. Next comes a base level of interoperability, where distinct EMR systems can connect with one another so that information from outside care providers becomes accessible.
But ultimately, Pearl envisions the barriers coming down entirely, with the distinctions between one vendor's product and another's melting away as developers stitch together the various systems and the EMR becomes a truly holistic record.
"The challenge [for] the community is you have a lot of different electronic medical records, and the real question is going to be what it's going to take to force the makers of these systems, not to make them interoperable -- that means I can go into your system and see it -- but actually to allow the APIs to be accessed by third-party developers that are now going to allow the creation of a single system," Pearl said. "It's going to be the patient's system. And that's going to be, I think, the real holy grail of American medicine."