Do EHRs result in better care? Many physicians say yes

The answers come in a federally funded survey meant to gauge the impact of a program rewarding doctors for meaningful use of electronic health records.

By — Posted July 30, 2012

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Electronic health record adoption rates continue to climb. And a new survey finds that the majority of EHR users are happy with their systems — and how much they can improve quality of care.

Results from the Centers for Disease Control and Preventions’ National Center for Health Statistics survey of 2011 EHR adoption trends, released on July 17, show that EHR use in physician offices reached 55% in 2011. This was up from 50.7% in 2010, when a similar NCHS survey was conducted. Of those users, 85% were either very or somewhat satisfied with their systems.

The NCHS survey found that nearly 75% of surveyed physicians who have adopted EHR said use of the system resulted in better care. The majority said they would purchase their EHR systems again. The survey of 3,180 physicians, which was funded by the Health and Human Services Dept.’s Office of the National Coordinator for Health Information Technology, was conducted by mail starting in early 2011. It was the first survey to come out of a three-year initiative to survey office-based physicians on EHR use. Respondents will be followed annually through 2013.

The survey is designed to discover the impact of a federal program giving physicians bonuses for meaningful use of EHRs, a program that went into effect in 2011. Under the incentive program, 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. The NCHS report found that 77% of EHR users have systems that meet meaningful use criteria.

While the NCHS report helped validate some of the ONC’s assessments of the health IT landscape in previous surveys conducted separately, said Jacob Reider, MD, acting chief medical officer at the ONC, “it also invalidates some of the anecdotes one may have heard,” he said. An oft-repeated anecdote is how unhappy physicians are with their EHR systems, he said.

Anecdotes of physicians being unhappy with their systems are partially based on widely repeated EHR horror stories. The stories usually involved the plot line of a practice spending thousands of dollars on an EHR system that it later scrapped only to spend thousands more on a second system that was more user-friendly.

Steven Waldren, MD, director of the American Academy of Family Physicians’ Center for Health IT, said he has heard plenty of stories of unhappy EHR users. But generally, the actual level of dissatisfaction is lower than the level portrayed in the complaints, he said. Physicians often are pegged as complainers because they want to improve things to the highest possible level, Dr. Waldren said.

But he was still a little surprised to see such a high number of satisfied physicians come out of the NCHS survey. A survey published in August 2011 by the American Academy of Family Physicians’ Family Practice Management found that only 39% agreed or strongly agreed that they would buy their EHR system again.

Dr. Waldren said family physicians, who made up the entire survey population for the Family Practice Management study, have been adopting EHRs at a faster rate than other specialties. He said that maybe a large number of them were using systems they adopted some time ago, which are not as advanced as the systems available today. The NCHS survey, on the other hand, included a large number of recent adopters who are using systems that are far more user-friendly than EHRs of the past.

The most recent NCHS survey broke down adoption rates by practice size and found that solo practices are lagging behind others with an adoption rate of 29% compared with 60% of two-physician practices and 86% for practices with 11 or more physicians.

“From a cost perspective, the proportion of investment that [solo practices] have to make in an IT system is a greater proportion than it is for a larger organization, even a two- to five-doctor practice,” said ONC’s Dr. Reider. The numbers in the survey show that the meaningful use incentive program is helping mitigate that, he said.

Other government surveys have tracked EHR adoption rates and have come up with different numbers than NCHS. For example, the Irvine, Calif.-based marketing research firm SK&A, which is contracted by the ONC to track EHR adoption trends, reported earlier in 2012 that for the second half of 2011, adoption rates for single-doctor offices jumped from 30.8% to 36.9%, making it the fastest growing segment. Dr. Reider expects future NCHS surveys to reflect a bump in solo practice adoption.

Even after the meaningful use program was launched, many physicians, especially those in solo practices, put off buying an EHR right away, Dr. Reider said. Many are overwhelmed by the decision. Through regional extension centers, the government is providing help to them, he said.

More than 60 RECs were established across the country to help small practices with the selection and implementation process of an EHR and to help prepare them for meeting meaningful use requirements. The centers had a goal of reaching a total of 100,000 physicians. As of July, more than 145,000 have signed up with them for help.

“The numbers are very encouraging,” Dr. Reider said.

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Who has adopted EHRs

The Centers for Disease Control and Preventions’ National Center for Health Statistics released the results of a 2011 survey on electronic health system adoption. Overall, 55% of office-based physicians have EHRs, but rates vary depending on a doctor’s age and practice status.

Physician/practice characteristic EHR adoption rate
All physicians 55%
Physicians younger than age 50 64%
Physicians age 50 and older 49%
Solo practice 29%
Two-physician practice 60%
Three- to 10-physician practice 62%
11- or more physician practice 86%
Academic health center 70%
Community health center 74%
HMO-owned practice 100%
Medical practice 55%
Physician-owned practice 50%
Primary care practice 58%
Surgical practice 48%

Source: “Physician Adoption of Electronic Health Record Systems: United States, 2011,” National Center for Health Statistics, July (link)

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External links

“Electronic Medical Record/Electronic Health Record Systems of Office-based Physicians: United States, 2009 and Preliminary 2010 State Estimates,” National Center for Health Statistics, December 2010 (link)

“Physician Adoption of Electronic Health Record Systems: United States 2011,” NCHS, July (link)

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