England's primary care physicians are the most advanced users of healthcare IT across the world, according to consultancy Accenture, but a widening gap in secondary or specialty care could undermine integrated care delivery.

For a research paper, Accenture questioned over 3,700 physicans and 160 health leaders from government and elsewhere across Australia, Canada, England, France, Germany, Singapore, Spain and the US, and found that England had the largest gap among the eight countries between IT maturity in primary and secondary care.

"Although the use of healthcare IT functionality is widespread across England there is a notable disparity between care settings." said Jim Burke, who leads Accenture's healthcare business in the UK and Ireland. "Clearly more needs to be done in secondary care in order to develop greater connectivity across the English healthcare system."

The Accenture "Connected Health: The Drive to Integrated Healthcare Delivery" study considers electronic entry of patient notes, e-referrals, e-ordering, e-prescribing and electronic communications with other clinicians.

The study found that England had the largest gap between IT maturity in primary care - where it was a leader - and secondary care, where it lagged behind the other countries studied.

In England more than 90 percent of primary care clinicians report entering patient notes on systems during or after consultations, the most of any country surveyed, but this drops to just 16 percent for secondary care, the lowest for any country surveyed.

In addition 84 percent of primary care clinicians claim they receive electronic alerts while seeing their patients, the most of any country in the survey, but this figure falls to just 7 percent in secondary care, again, the lowest of all countries.

In primary care settings, 47 percent of physicians in England claimed their organisation uses electronic tools to ease the administrative burden, which is lower than all but one of the other countries. For hospital and specialist care clinicians, this figure drops to 25 percent, which is well below the 49 percent international average.

Almost 30 percent of primary care physicians claim using clinical decision support to help make treatment decisions, which drops to just 13 percent in secondary care.

A high proportion of English physicians reported that patients' clinical data is shared across their organisation to improve care protocols and clinical outcomes - 92 percent and 70 percent across primary and secondary care respectively.

"A common misconception is that the one key to connected health success is having the right technology, when in fact there are many factors - the most important being change management and collaboration," said Burke.

The NHS is set to push IT decision making locally, but the government has not yet decided on a funding regime, it was reported earlier this month. NHS Connecting for Health resources director Alan Perkins said the funding model to support trusts was "still under development".