Seventy-one percent of physicians have adopted an electronic health record (EHR), and 85% of adopters have an EHR certified for meaningful use, according to a new report based on 2013 data from the Office of the National Coordinator for Health Information Technology (ONC).
An additional 10% of physicians plan to adopt an EHR, the report found. Eleven percent of physicians are uncertain, and 8% have decided not to adopt. Of those who have no plan to acquire a system, four in 10 are retiring.
Solo practice physicians have the highest percentage of physicians who are uncertain about EHR adoption or who do not plan to adopt. Among different specialty types, surgeons include the largest group of physicians (9%) who do not intend to adopt.
Despite the progress made in the last few years, physicians in large multispecialty groups still have much higher adoption rates than those in small practices. There is no difference in adoption, however, between rural and urban practices. This shows that "rural physicians can be as sophisticated as their urban counterparts," noted Peter Basch, MD, medical director for ambulatory EHR and health information technology policy at MedStar Health in Washington, DC.
The report also found that 77% of primary care physicians have implemented EHRs vs 68% of medical specialists and 63% of surgeons.
Primary care physicians are more likely to have EHRs partly because they tend to work for hospitals and large groups that have these systems, said Catherine DesRoches, a senior survey researcher at Mathematica Policy Research, in an interview with Medscape Medical News. Also, she noted, "Many EHRs are not set up for specialists." Their functions are oriented to primary care, and specialists, particularly surgeons, have difficulty finding EHRs that meet their needs.
Follow the Money
The ONC survey shows a sharp divide between the factors that motivated physicians to adopt EHRs, depending on whether or not they implemented a system before 2009. That was the year Congress passed the HITECH Act, which authorized the government's meaningful use EHR incentive program. Just 23% of the early adopters were motivated by financial incentives or penalties, whereas that factor influenced 62% of the later adopters.
Basch, an EHR pioneer, told Medscape Medical News he was surprised that so many of his peers reported they had received financial incentives for adoption before 2009. "There were occasional insurance programs for pilot projects, but the biggest group of adopters pre-HITECH were people who had a strong belief in the power of technology to solve problems."
Board certification requirements influenced 39% of later adopters, but only 7% of the pioneer group. Other major factors that motivated the more recent adopters were trusted colleagues using EHRs (37%), electronic exchange capability (36%), technical assistance with EHR implementation (35%), and assistance with selecting an EHR (17%).
Basch does not believe many early adopters thought of electronic data exchange the way EHR users do today, because there was little online information exchange between healthcare providers then. EHR users did, however, receive laboratory results electronically, and they were prescribing online as well, which may explain why 27% of them said data exchange was a motivating factor in their EHR purchase.
Although health information exchange was not the top factor for later adopters, its importance for a third of this group, as well as for 39% of those who had not adopted yet, shows that a large plurality of physicians value the ability to communicate electronically with other healthcare providers. However, Basch cautioned that most physicians are still unhappy with the mechanisms for doing so.
Technical Assistance Important
The availability of technical assistance is significant to a third of EHR adopters and to 46% of those who have not adopted, coming in just behind financial incentives and penalties as a reason to acquire an EHR. This is especially true in smaller practices, for which a lack of technical support has been a barrier to adoption, DesRoches said.
"The costs of technical assistance and maintenance can be a big barrier for smaller practices," she pointed out. "And getting the attention of vendors can be a problem for them."
ONC's regional extension centers have helped many small practices in this regard, she added. However, federal funding for the centers ended last April 15, unless they had money left over in their budgets.
The money available for EHR incentives is also running out, a fact to which ONC alluded obliquely in its news release about the report. The agency pointed to the effect that financial incentives have had on adoption, including not only meaningful use payments but also the fees that Medicare pays physicians under its chronic care management program.
DesRoches doubts that the latter fees alone will prompt physician holdouts to adopt EHRs, but it is possible, she added, that the fees for managing patients with chronic disease, plus the threat of penalties for not showing meaningful use, might push some physicians over the line to adoption.
In addition, she said, it will be hard for independent physicians to adapt to current market trends such as accountable care organizations and patient-centered medical homes without a "functional" EHR. "To the extent those things take hold, that would push for more EHR adoption," DesRoches said.
Basch believes the new care delivery models, as well as chronic care management fees, will keep the health information technology momentum going, even after meaningful use dollars dry up. "It's a matter of creating a compelling and sustainable business case for health information management and quality outcomes in a healthcare system where healthcare is paid for differently than it is today," he said.