The low adoption of electronic medical records and e-prescribing is well known. Now, a new study has worse news: most physicians do not use inexpensive, widely accessible IT tools in their practice.

The study, to be published in November in the Journal of General Internal Medicine, finds that fewer than 4 percent of physicians e-mail with patients, about 30 percent e-mail with other clinicians and about 40 percent use real-time computerized decision support, including government and professional society Web sites and searchable databases.

Though recent medical school graduates were more likely to use IT than more-experienced doctors, doctors in solo or two-person practices were less likely to use IT regardless of age.

Only 12 percent of doctors in solo/IT practices used most of the basic IT tools queried in the survey. Over 40 percent of doctors working in HMOs or academic practices use such tools.

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Richard Grant, lead author of the study and faculty member at Harvard Medical School, said one of the goals of the survey was to look at the use of IT that did not require huge capital investments.

Internet access and e-mail, after all, are available in nearly every office in the United States.

Why is it that nearly most of physicians use e-mail in their personal lives, but only a few percent e-mail patients? Steve Grant, lead author of the study says most of the blame rests on how community practices are set up.

"It's not that doctors are dragging their heels because they don't want to use the stuff," he said.

Instead, he blames the systems and work flow in which doctors deliver care. How doctors see patients, and how their offices are structured, rarely put IT tools at doctors' fingertips, Grant said.

HMOs and academic practices are more likely to establish systems and routines that encourage the use of IT, he said.

The fact that many physicians do not use IT tools even when they are freely accessible mean that workflows and routines must be engineered to incorporate IT, Grant said.

Another issue is that doctors typically do not get paid for activities that occur outside a patient visit.

Report: State, local health IT spending to swell. Click here to read more.

For example, many doctors figure e-mailing can only hurt them. Not only will they not be paid for their e-mail tasks, doctors worry that the contents of their e-mails, whether to patients or fellow clinicians, could be used against them in legal cases.

Though the survey reports results of a mail-in survey completed in 2004, Grant said rates of IT use may have increased since then, but probably haven't jumped since the IT tools surveyed were already extremely accessible.

Lack of Internet use can also mean that online surveys have to be taken with a grain of salt.

A recent online survey conducted by HarrisInteractive for McKesson found that 74 percent of physicians were thinking of installing electronic health records systems in their practices.

Of those, more than 90 percent of physicians planned to implement electronic medical records within three years.

Such surveys, said Grant, probably do not accurately represent solo and small-practice physicians.

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