More EMRs are in physician offices, but use still lags

While federal incentives are expected to spur growth, they won't be the primary driver for adoption or added functionality, experts said.

By Pamela Lewis Dolan — Posted Feb. 1, 2010

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Physicians increasingly are adopting electronic medical records systems, even before government economic incentives for doing so have kicked in. But a survey by the Centers for Disease Control and Prevention also found those doctors weren't yet doing a whole lot with the technology.

The CDC's National Center for Health Statistics said an estimated 43.9% of doctors are using full or partial EMRs, up from 34.8% in 2007 and 41.3% in 2008. The use of what was described as "fully functional" systems also went up from 3.8% in 2007 and 4.4% in 2008, to 6.3% in 2009. The survey did not include systems used for billing.

Experts said the survey showed that while more physicians are embracing health information technology, it's not a full embrace. Doctors are starting slowly, with individual functions such as electronic prescribing.

"There's definitely progress and the question is, is it fast enough," said Anne-Marie Audet, MD, vice president for the Program on Quality Improvement and Efficiency at the Commonwealth Fund. The organization's own study of physician EMR use, released in November 2009, found usage rates similar to the CDC study.

Experts don't expect the numbers found in the CDC study to accelerate significantly, despite the presence of a maximum $44,000-per-physician tax incentive through the American Recovery and Reinvestment Act, and other incentives from Medicare and Medicaid set to begin in 2011. (See correction)

"One thing the stimulus has done is it's gotten [the vendors] a lot more phone calls," said Bruce Carlson, publisher of Kalorama Information, a market research firm in New York that focuses on health information technology. "A lot of questions, but only a limited amount of buying."

Carlson said barriers to adoption for physician practices, including a disruption to work flow and a preliminary loss of productivity, are so strong that "the stimulus alone is not going to push the issue." But vendors are creating systems that will produce a quicker return on investment, which is more of a motivator than the incentive funds, he said.

Carlson said many physicians have adopted EMRs because they were attracted to relatively simple functions such as e-prescribing and computerized physician order entry. Generational and geographic factors also play into whether a physician adopts a system, experts said.

That explains why there is a large gap between the percentage of doctors who reported having an EMR system and the percentage of physicians who said they have only what is defined as a basic system -- one that includes patient demographic information, patient problem lists, clinical notes, prescriptions orders, and lab and imaging results.

For example, only 20.5% of office-based physicians had what the CDC termed a basic system. That was up from 16.7% in 2008 and 11.8% in 2007. A fully functional system, which still hasn't reached a double-digit percentage of doctors, has everything that a basic system includes, plus more, such as warnings of drug interactions or contraindications, medical history and follow-up, and orders for tests.

Impacts on adoption

Dr. Audet said many office-based physicians have been persuaded by various research showing that EMRs could make billing more efficient and drive up revenue. Adding to the financial benefits were reimbursements for quality reporting and e-prescribing for Medicare and Medicaid patients, she said.

With government incentives starting in 2011 for EMR use, adoption rates are expected to rise, said Chun-Ju Hsiao, PhD, a researcher who helped write the CDC study.

Kalorama's Carlson said incentives will have an impact but won't be the primary driver that will close the gap between those who use EMRs and those who don't. And, he said, the incentives will have even less of an impact on closing the gap between basic and fully functional EMR use.

A December 2009 report by the market research firm, which interviewed health IT vendor executives, found that the market for EMRs was $12 billion in 2008 and is expected to rise to $25.4 billion by 2013. But the majority of the increase represents sales to hospitals.

A trend of practices being purchased by hospital groups that buy, or heavily subsidize, EMR systems for the practices has helped push physician adoption, experts said.

Many experts have said that even with the incentives, the cost of a system -- and the loss of revenue a practice can expect when installing and adjusting to it -- still have many physicians believing an EMR is an expensive investment with little return.

Dr. Audet agreed that incentives are not going to lead to an overnight interest in adoption. But that doesn't mean they won't be effective.

"If we only see a 10% increase in adoption during the first wave of incentives," she said, "I don't think we should say, 'Well, this is a failure.' Actually, it would be pretty good. But it's going to inform the next wave."

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EMR use by physicians

While overall use of electronic medical records has increased, office-based physicians are using them in limited ways, according to a survey by the Centers for Disease Control and Prevention. "Overall use" includes anyone with an EMR. "Basic system" means one with a minimum of six certain functionalities. "Fully functional" means a system with functionalities beyond a basic system.

Overall use Basic system Fully functional
2009 43.9% 20.5% 6.3%
2008 41.3% 16.7% 4.4%
2007 34.8% 11.8% 3.8%
2006 29.2% 10.5% 3.1%

Note: 2009 numbers are estimated. Other years' numbers are based on response to mail and in-person surveys.

Source: National Ambulatory Medical Care Survey, National Center for Health Statistics, Centers for Disease Control and Prevention, released December 2009

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External links

"Electronic medical record/electronic health record use by office-based physicians: United States, 2008 and preliminary 2009," National Ambulatory Medical Care Survey conducted by the National Center for Health Statistics, Centers for Disease Control and Prevention, December 2009 (link)

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The source of the $44,000 per-physician incentive available to physicians for meaningful use was misidentified. It is money available through the federal stimulus package. American Medical News regrets the error.

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