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Any, Certified, and Basic: Quantifying Physician EHR Adoption through 2014

ONC Data Brief 28 | September, 2015

Dawn Heisey-Grove, MPH; Vaishali Patel, PhD MPH

Physician adoption of electronic health record (EHR) systems has increased substantially over the last decade (1,2). As a result, health information technologies (IT) have evolved to include functionalities that better address what physicians need. In 2003, the Institute of Medicine (IOM) developed a definition for a Basic EHR (3) that included selected measures designed to promote safety. A certified EHR applies standards for electronic data capture and exchange of patient health information (4). The Office of the National Coordinator for Health IT's Certification Program allows providers to purchase only those certified health IT components that met their needs. By 2014, the National Electronic Health Record Survey began capturing physician use of a certified EHR. This brief provides estimates of office-based physician EHR adoption rates by 2014, for any EHR, certified EHR, and Basic EHRs.

More than 8 in 10 physician had adopted an EHR.

Figure 1: Proportion of physicians who reported using an EHR by type of EHR, 2014

Figure 1 is a bar chart showing the percent of physicians who reported using any EHR by the type of EHR, 2014. 83% of physicians reported using Any EHR; 74% reported using a Certified EHR and 51% reported using a Basic EHR.

SOURCE: Jamoom E, Yang N, Hing E. Percentage of office-based physicians using any electronic health records or electronic medical records, physicians that have a basic system, and physicians that have a certified system, by state: United States, 2014 (table). 2015.

While the majority of physicians used most Basic EHR functionalities, only 6 in 10 electronically viewed imaging results.

Figure 2: Proportion of physicians who reported using computerized functionalities that met Basic EHR criteria, 2014.

Figure 2 is a bar chart and shows that physicians used computerized functionalities that met Basic EHR criteria to perform the following: 86% of physicians reported Recording demographic information; 86% reported using Computerized prescription order entry; 84% reported Recording patients medications and allergies; 83% of physicians reported Recording clinical notes; 82% of physicians Reported recording patient problem lists; 78% of physicians reported viewing laboratory results; and 61% reported viewing imaging results.

SOURCE: 2014 National Electronic Health Record Survey.

A majority of physicians used certified EHRs, regardless of their participation in the EHR Incentive Program.

Figure 3: Proportion of physicians participating, or planning to participate, in CMS' EHR Incentive Program, by EHR type, 2014.

Figure 3 is a stacked bar chart and shows that 62% of physicians applied or planned to apply to participate in the CMS EHR Incentive Program, and that 56% are using a Certified EHR, 3% are using an uncertified EHR, and 3% have No EHR. 38% of physicians will not not apply or were uncertain of their plans to apply to participate in the CMS EHR Incentive Program, and 18% are using a Certified EHR, 6% are using an uncertified EHR, and 14% are using No EHR.

SOURCE: 2014 National Electronic Health Record Survey. Two percent of physicians did not respond to the question about intent to apply to the Medicaid and Medicare EHR Incentive Programs, and were not included in the analysis.

Primary care physicians reported the highest rates of adoption for any EHR, certified EHR, and Basic EHR.

Figure 4: Proportion of physicians who reported using an EHR by specialty, 2014.

Figure 4 is a bar chart and show that 87% of Primary Care physicians reported using Any EHR (79% had a Certified EHR and 8% had an uncertified EHR), and 56% were using all Basic EHR functionalities. 80% of Medical Specialists reported using Any EHR (70% had a Certified EHR and 10% had an uncertified EHR), and 46% reported using all Basic EHR functionalities. 78% of Surgical Specialists reported using Any EHR (70% had a Certified EHR and 8% had an uncertified EHR), and 47% reported using all Basic EHR functionalities.

SOURCE: 2014 National Electronic Health Record Survey.

Solo practitioners had the lowest rates of adoption for any EHR, certified EHR, and Basic EHR.

Figure 5: Proportion of physicians who reported using an EHR by practice size, 2014.

Figure 5 is a bar chart and shows that 64% of Solo practitioners had Any EHR (55% had a Certified EHR and 9% had an uncertified EHR), and 31% reported using all Basic EHR functionalities. 87% physicians in practices of 2 to 5 physicians had Any EHR (78% had a Certified EHR and 8 had an uncertified EHR), and 46% reported using all Basic EHR functionalities. 89% of physicians in practices of 6 to 10 physicians had Any EHR (81% had a Certified EHR and 8% had an uncertified EHR), and 63% reported using all Basic EHR functionalities. 97% of physicians in practices of 11 or more physicians had Any EHR (86% had a Certified EHR and 11% had an uncertified EHR), and 82% reported using all Basic EHR functionalities.

SOURCE: 2014 National Electronic Health Record Survey.

Physicians in community health centers reported the highest adoption rate for any EHR; but had low rates for certified and Basic EHR adoption.

Figure 6: Proportion of physicians who reported using an EHR by practice ownership, 2014.

Figure 6: Proportion of physicians who reported using an EHR by practice ownership, 2014.

SOURCE: 2014 National Electronic Health Record Survey.

Summary

These data demonstrate that as of 2014, a majority of office-based physicians have adopted EHRs. More than 8 in 10 physicians had adopted any EHR, almost three-quarters of physicians had adopted a certified EHR, and a little over half of office-based physicians were using all functionalities associated with a Basic EHR. Rates of Basic EHR adoption were lower because only 6 in 10 physicians were using "viewing imaging results", one of the Basic EHR criteria. Adoption of each of the other Basic EHR criterion was above 80%.

Findings of disparities in adoption among physicians located in solo and small group practices and physician- and group-owned practices, as well as among non-primary care specialties are consistent with prior literature (6,7,8,9). In addition, large differences in Basic EHR adoption were observed among solo and small group practice physicians, and within physician and group-owned practices and community health centers. These findings may be related to the fact that the Basic EHR definition includes functionalities that apply primarily to certain physician specialties and may not be broadly applicable across the care continuum.

In contrast, disparities in certified EHR use were less prevalent among office-based physicians. Physician adoption of certified EHRs was within 10 percentage points of overall EHR adoption, with the exception of physicians in practices of more than 10 physicians and in community health centers. Adoption of certified EHRs was common even among physicians not participating in the Incentive Programs; almost half of these physicians indicated they used a certified EHR.

Definitions

Any EHR: Physicians indicated that their reporting location used electronic medical records, not including medical records

Basic EHR: Physicians indicated that their reporting location used all of the following computerized functions: record patient demographics, computerized prescription order entry, viewed laboratory and imaging results, and recorded clinical notes, patient medications, allergies, and problem lists.

Certified EHR: Physicians indicated that their reporting location used an EHR, and that EHR being used at the reporting location met the criteria for Meaningful Use (5).

Data Source and Methods

The Centers for Disease Control and Prevention conducts the NEHRS survey on an annual basis. Physicians included in this survey provide direct patient care in office-based practices and community health centers; excluded are those without direct patient care (radiologists, anesthesiologists, and pathologists). Additional documentation regarding the survey is available here: http://www.cdc.gov/nchs/ahcd/ahcd_survey_instruments.htm#namcs. Descriptive statistics were based on weighted frequencies generated using SAS v9 proc surveyfreq.

References

1. Hsiao C-J, Hing E. (2014) Use and characteristics of electronic health record systems among office-based physician practices: United States, 2001-2013. NCHS data brief, no 143. Hyattsville, MD: National Center for Health Statistics.

2. Office of the National Coordinator for Health Information Technology. 'Office-based Physician Electronic Health Record Adoption: 2004-2014,' Health IT Quick-Stat #50. http://dashboard.healthit.gov/quickstats/pages/physician-ehr-adoption-trends.php. September 2015.

3. Institute of Medicine. (2003). Key capabilities of an electronic health record system. Retrieved from http://iom.nationalacademies.org/Reports/2003/Key-Capabilities-of-an-Electronic-Health-Record-System.aspx.

4. US Department of Health and Human Services. (2012) Health Information Technology: Standards, Implementation Specifications, and Certification Criteria for Electronic Health Record Technology, 2014 Edition; Revisions to the Permanent Certification Program for Health Information Technology. 45 CFR 170. Federal Register.

5. Centers for Medicare and Medicaid Services. (2010). Medicare and Medicaid Electronic Health Record Incentive Program - stage 1 final rule: 42 CFR parts 412, 413, 422, and 495. Federal Register.

6. Xierali IM, Phillips RL, Green LA, Bazemore AW, Puffer, JC. Factors influencing family physician adoption of electronic health records (EHRs). J Am Board Fam Med. 2013 ; 26(4), 399-393.

7. Decker, S. L., Jamoom, E. W., & Sisk, J. E. (2012). Physicians in nonprimary care and small practices and those age 55 and olders lag in adopting electronic health record systems. Health Affairs, 31(5), 1108-1114.

8. Furukawa, M. F., King, J., Patel, V., Hsiao, C.-J., Adler-Milstein, J., & Jha, A. K. (2014). Despite Substantial Progress In EHR adoption, Health Information Exchange and Patient Engagement Remain Low in Office Settings. Health Affairs, 33(9), 1672-1679.

9. Sowmya, R. R., DesRoches, C. M., Donelan, K., Campbell, E. G., Miralles, P. D., & Jha, A. K. (2011). Electronic health records in small physician practices: availability, use, and perceived bene?ts. J Am Med Inform Assoc, 18, 271-275.

About the Authors

The authors are with the Office of the National Coordinator for Health Information Technology, Office of Planning, Evaluation, and Analysis and the Office of Clinical Quality and Safety.

Suggested Citation

Heisey-Grove, D., Patel, V. (September 2015) Any, Certified, or Basic: Quantifying Physician EHR Adoption. ONC Data Brief, no. 28. Office of the National Coordinator for Health Information Technology: Washington DC.