Utilisation of information technologies in ambulatory care in Switzerland.
BACKGROUND
The importance of electronic medical records for the healthcare system is well documented. IT enables easy storage, communication and decision support and can provide important tools in the care of chronically ill patients in the form of a reminder system.


METHODS
A questionnaire was developed and send out to 1200 physicians extracted from the official data base. After four weeks the non-responders received a written reminder. Data collection started in December 2007 and was completed in February 2008.


RESULTS
719 questionnaires were received back, representing a response rate of 59.9%. The data revealed a significant underuse of electronic medical records (EMRs) and IT compared to other European countries. Smaller practices, older physicians and especially primary care physicians tended to use less EMR. Only 10.2% of all physicians declared an interest in considering investment in IT in the next three years, 66.9% expressly denied wishing to do so. The most important barriers were the costs, the unclear benefit and a feared worsening of the doctor-patient-communication during consultation.


CONCLUSIONS
IT and especially EMRs are underused in daily ambulatory care in Switzerland. To increase the use of EMRs, several approaches could be helpful. First of all, the benefit of EMRs in daily routine care have to be increased as, for example, by decision support systems, tools to avoid pharmaceutical interactions and reminder systems to enable a proactive treatment of chronically ill patients. Furthermore, adequate approaches to offer appropriate reimbursement for the financial investments have to considered such as an additional payment for electronically generated, evidence based quality indicators.
Rosemann
Thomas
T
Institute of Primary Care and Health Services Research, University of Zurich, 8091 Zürich, Switzerland. thomas.rosemann@usz.ch
Marty
Franz
F
Bhend
Heinz
H
Wagner
Judith
J
Brunner
Lorenzo
L
Zoller
Marco
M
D000553:Ambulatory Care / Q000191:economics / Q000592:standards*; D001291:Attitude of Health Personnel; D002908:Chronic Disease / Q000628:therapy; D003201:Computers / Q000191:economics / Q000706:statistics & numerical data; D003365:Costs and Cost Analysis; D003431:Cross-Cultural Comparison; D057286:Electronic Health Records / Q000191:economics / Q000706:statistics & numerical data*; D005060:Europe; D005260:Female; D006302:Health Services Research / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008511:Medicine / Q000706:statistics & numerical data; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000191:economics / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000191:economics / Q000706:statistics & numerical data; D012984:Software / Q000191:economics / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D013557:Switzerland