Physician EMR use passes 50% as incentives outweigh resistance

For the first time, a majority of office-based physicians are using an electronic medical records system, according to a survey by the Centers for Disease Control and Prevention's National Center for Health Statistics.

The survey doesn't explain why EMR use in offices rose to 50.7% in 2010, more than double the adoption rate in 2005. However, peer pressure is apparently moving from fighting EMRs to embracing them. "We're in an electronic age. You either go with it, or you're in the Dark Ages," said Pat Willis, RN, chief nursing officer for seven-physician Big Sandy Healthcare, in eastern Kentucky, which installed its first EMR in July.

The transition has happened for a number of reasons, technology analysts say. One is simple demographics: As more older physicians retire and more freshly minted doctors join the work force, the resistance to EMRs lessens. (A previous 2010 CDC report said the younger the doctor, the more likely he or she was to embrace EMRs.) But the resistance has lessened even among older physicians, who have grown more comfortable with EMRs as they have become more common in offices and hospitals. "The fear factor is dissipating," said Mary Shacklett, CEO of Transworld Data, a technology research and consulting firm in Olympia, Wash.

Another major factor: financial assistance and incentives to get physicians to adopt.

In 2006, the Dept. of Health and Human Services granted Stark law exceptions and anti-kickback safe harbors to hospitals through Dec. 31, 2013, so they could help affiliated practices finance EMRs and other technology. A July 2010 study from consulting firm CSC said one-third of hospitals have offered financial assistance to physicians for EMRs, and more than 60% of hospitals offer physicians access to the hospital's EMR and a hosted EMR for physicians delivering ambulatory care.

In 2009, the American Recovery and Reinvestment Act -- the stimulus package -- included incentives for what it called meaningful use of EMRs. Physicians who meet all required objectives could receive as much as $44,000 over five years from Medicare, or $63,750 over six years from Medicaid.

Meanwhile, the act created a committee that would set standards for EMRs so that systems could communicate with one another. That is one of the standards for meaningful use, and something that would lessen the financial risk of buying an EMR, so physicians wouldn't be stuck with replacing a system that couldn't share information with others.

For Big Sandy Healthcare, financial incentives weren't even a consideration when it began searching for an EMR in 2008, because they didn't exist. But the practice intends to take advantage of them. "That was one of those things where we said, 'Hooray! This will help us!' " Willis said.

Snapshot of use

The latest CDC information on EMR use, released on Dec. 14, 2010, was based on surveys mailed to 10,301 physicians between April and July 2010. About two-thirds of physicians responded to the survey, according to the CDC. The 50.7% of physicians estimated to use such systems in 2010 was up from 48.3% in 2009, 42% in 2008 and 34.8% in 2007. The 2010 estimate is preliminary, because it relies only on the mailed responses and not answers gathered through follow-up calls. The CDC National Center for Health Statistics counted as an EMR any system that is all or partially electronic and is not used exclusively for billing.

The CDC survey release did not include physicians' answers to questions about applying for meaningful use incentives. But it did release numbers indicating that even though a majority of physicians might have access to EMRs, many were a long way from qualifying for incentives.

According to the survey, 24.9% of office-based physicians had access to a "basic" EMR system, while only 10.1% had a "fully functional" system. The CDC defined a basic system as having components such as patient history and demographics, patient problem lists, physician clinical notes, computerized orders for prescriptions, and the ability to view lab and imaging results. A fully functional system has everything a basic system does plus the outside communications necessary for qualifying for meaningful use, such as the ability to send test orders and prescriptions electronically.

Technology analysts explained the gap this way: Many physicians start with EMRs with only a few functionalities, such as electronic prescribing, before moving to a larger system.

The survey showed a wide variation in the rate of EMR adoption by state, from 80.2% in Minnesota to 38.1% in Kentucky.

Shacklett said the variation often reflects how long ago government and large hospital systems in states began pushing EMR use, including state-level financial incentives.

In Utah, where the reported EMR adoption rate was 73.2%, the predecessor to Intermountain Healthcare in Salt Lake City adopted its first EMR in 1967. "Clearly, many physicians in Utah have been exposed to EMR, and much of that exposure has been through Intermountain," said Marc Probst, the system's chief information officer and vice president of information systems. But he said Intermountain was not the primary driver of adoption -- not with independent physicians picking up the technology ball and running with it.

The common wisdom of why a state like Kentucky would have a lower adoption rate is that it has older, more rural physicians. But a 2010 survey of rural practices by the Kentucky Medical Assn. found that 55% of them already had EMRs, and many that didn't have one wanted one.

The state has many programs to boost EMR use. In late September 2010, the KMA received a $143,492 grant from the Physicians Foundation to assist doctors with the adoption and use of health information technology. State efforts are ongoing to help assist doctors with setting up EMRs. Kentucky colleges are training the unemployed to automate medical records, a skill needed to transfer paper records to electronic form.

Willis said Big Sandy Healthcare is fielding questions from practices around the country about how it managed its transition to EMRs. She tells them there is an initial slowdown in patient traffic as the practice adjusts to the new system (a reason a CDW Healthcare survey in December 2010 found an upfront cost of $120,000 per physician for EMR adoption, with only 12% of that hardware and software costs).

But she said things return to normal, or better, once kinks are worked out -- a reason that same CDW survey said doctors noticed a 15% increase in productivity when the transition period is over.