Only 10% of Doctors Using Complete eHealth Records Systems, Surveys Find
Combined data from two surveys of U.S. physicians taken over the past two years shows that while there has been a marked increase in the number of doctors using electronic health records (EHRs), the overall number of fully-functional systems remains in the high single digits to low double digits.
Preliminary estimates from the 2010 National Ambulatory Medical Care Survey (NAMCS) , which is conducted by the U.S. Centers for Disease Control (CDC), showed that the percentage of physicians with EHRs that met the criteria of a basic EHR system by state ranged from 12.5% to 51.5%.
However, after excluding 27 states with unreliable estimates, the percentage of physicians having systems that met the criteria of a fully functional system across the United States ranged from 9.7% to 27.2%.
A comparison of 2009 and 2010 surveys showed the number of physicians with systems that met the criteria of a basic or a fully functional system increased by 14.2% and 46.4%, respectively.
The federal government has been using a carrot and stick-approach to prod physicians and hospitals into deploying EHRs that meet its "meaningful use" criteria.
Physicians may receive as much as $44,000 under Medicare and $63,750 under Medicaid, and hospitals may receive millions of dollars for implementation and meaningful use of certified EHRs under both Medicare and Medicaid.
Those that don't implement EHRs by 2015 will begin being penalized through cuts in Medicare payments. Phase I of its meaningful use criteria -- all 864 pages of it -- was released last year. Phases II and III are expected out by the end of this year and 2013, respectively.
Currently there are 23 measures proposed that hospitals must implement before the end of this year to gain the maximum amount of reimbursement under the American Recovery and Reinvestment Act.
Dr. Tom Handler, a radiologist and analyst for the research firm Gartner, said one of the main barriers to adoption, "valid or not," are concerns about the productivity and usability of EHR systems. Many physicians also believe that the data collected by the government through EHR reporting criteria will be used to decrease Medicare and Medicaid reimbursements, Handler said.
"Ultimately, what I hear doctors saying is, 'Let me get this straight. You want me to spend money to put in a system that will be harder to use and slow me down, so I will earn less money, and that the end result is that someone else makes more money," Handler said. "If you phrase it that way, it's not illogical to see why they don't want to do it."
E-prescribing is another example. "Docs say, 'I didn't go to medical school to become a data entry clerk so Walgreens could hire one less pharmacy tech to enter the system.'"
Handler said current meaningful use criteria also doesn't take aim with incentives that address what physicians consider some of the most critical reforms needed in healthcare today.
For example, Handler said, a computer-based patient record system can catch duplicate patient test orders, but the current meaningful use incentives don't penalize physicians for ordering duplicate tests.
Ultimately, it's the patient -- the insurance company and then society -- that pays for the duplicate test, and yet, its the physician who'll have to foot the cost for the system that can prevent the duplicate tests, he said.
Dr. Harry Greenspun, chief medical information officer for Dell and a member of the Healthcare Information and Management Systems Society (HIMMSS), said resistance to EHR adoption can be as simple as a physician not wanting to add steps to a process that has worked for decades.
"It's really easy to write a prescription; you just jot it down on note paper. On a computer screen it can take a lot longer," he said. "If you go have to through a check list or a menu-driven program, it can be clunky, and a barrier to adoption."
"On the other hand," he continued, "If I can share [radiological] images, pull data from other systems, write a prescription all from one screen ... and get valid prescription alerts and find out about public health threats, then the value is obvious."
The CDC said there has been an increasing trend in EHR use among office-based physicians from 2001 - when the first survey was conducted -- through the preliminary 2010 survey estimates.
Combined data from the surveys taken in 2009, for example (both mail survey and in-person surveys), showed that 48.3% of physicians reported using all or partial EHR systems in their office-based practices.
About 21.8% of physicians reported having systems that met the criteria of a basic system, and about 6.9% reported having systems that met the criteria of a fully functional system, a subset of a basic system.
The CDC's National Centre for Health Statistics (HCHS) received survey responses from 70% of 3,200 physicians surveyed in person and 2,000 surveyed through a mailing. In 2010, NCHS surveyed a sample of 10,301 physicians with the mail survey and followed up with telephone calls to non-respondents. In all, about 66% responded, it said.
Dr. John Halamka, CIO of CareGroup and the associate dean of Harvard Medical School, said that although the numbers are currently low, more has been done toward implementing EHRs this past year than in the last 20.
"I'm not sure [physicians] don't want to implement EHRs. Implementing technology is rarely about bits, bytes, software and hardware. It's 80% change management," Halamka said. "If you walk into paper-based practices and say I want to digitize records, it would accomplish nothing. It's about how the office should perform its work differently."
Beth Israel Hospital, part of CareGroup, was able to convert 80% of its 1,700 physicians over to a standardized EHR system that resides in a private, cloud -based data center . "I said 80% of the cost will be covered by me and you no longer have to do [data] backups," Halamka said. "Their costs were reduced, expertise was brought in to help them and their infrastructure resided in the cloud."
Halamka said he believes this year will be a tipping point for EHR adoption, due to the fact that "meaningful use" standards are now published, vendors are getting their products certified and physicians and hospitals taking advantage of government-sponsored regional extension centers to help them deploy EHR technology.
"Just look at Massachusetts. We're already at more than 50% adoption," he said.
Lucas Mearian covers storage, disaster recovery and business continuity, financial services infrastructure and health care IT for Computerworld. Follow Lucas on Twitter at @lucasmearian or subscribe to Lucas's RSS feed . His e-mail address is firstname.lastname@example.org .
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