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EHR adoption rate slows, with physicians facing big hurdles for meeting Stage 2, survey finds


By Joseph Conn
Posted: January 20, 2014 - 12:45 pm ET
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The pace of adoption of electronic health-record systems has begun to slow, and the physicians who have adopted systems have a long way to go to meet the government's Stage 2 criteria for meaningful use of the technology, according to an authoritative survey of practices by the National Center for Health Statistics at HHS.

In 2013, the third year of the federal EHR incentive payment program, nearly 8 in 10 office-based physicians had adopted some form of an electronic health-record system and nearly half of them had a “basic” system with key EHR functions defined.

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The latest installment of the annual National Ambulatory Medical Care Survey, conducted between February and June last year, also showed that most physicians were far from meeting the incentive payment program's Stage 2 “meaningful use” criteria. For physicians who had met at least two years of Stage 1 requirements, Stage 2 got underway Jan. 1.

Dr. Karen DeSalvo, HHS' new national coordinator for health information technology, described the survey results in a blog post as “encouraging.”

The randomized NCHS survey was conducted by mail and phone and had 10,302 physicians in its sample.

About 78% of respondents in 2013 answered “yes” to the question, “Does this practice use electronic medical records or electronic health records (not including billing records)?” according to a NCHS “data brief” that presents the survey results. These respondents are classified by NCHS as having “any EHR.”

Use of EHRs that meet that broad definition was up by just 6.6 percentage points, from 71.8% in 2012, after jumping nearly 15 percentage points in 2012 over 2011. Just 18.2% of physicians used any EHR in 2001 when the NCHS began reporting data on health IT system adoption.

The survey also indicates a wide variance between the states in adoption rates for any EHR, ranging from a low of 66% in New Jersey to a high of 94% in Minnesota.

Survey respondents also were asked whether their EHRs were capable of performing a specific list of functions, including the capability of recording patient demographics; creating problem lists and clinical notes; writing electronic prescriptions; and displaying lab and imaging results.

Based on the number of functions selected, these more robust systems were classified by NCHS as either a “basic” or a “fully functional” EHR.

The 2013 adoption rate for a basic EHR was 48.1%, up from 39.1% in 2012 and 33.1% in 2011 and 10.5% in 2006, the first year the NCHS reported information about EHR functionality in its survey.

Splits in adoption of basic EHRs by states was remarkably wide, too, ranging from a low of 21% in New Jersey to a high of 83% in North Dakota.

Rates for multifeatured, “fully functional” EHRs also rose significantly, albeit from even lower levels of adoption, to 31.1% in 2013 from 23.5% in 2012 and 16.8% in 2011. Just 3.1% of physician offices reported having a fully functional EHR in the 2006 survey.

Only about 13% of all office-based physicians reported that they both intended to participate in Stage 2 of the federal EHR incentive payment program and “had EHR systems with the capabilities to support 14 of the 17 Stage 2 core set objectives for meaningful use.”

Physicians and other “eligible professionals” must meet all 17 core objectives of Stage 2 to receive payment.

But 69% of physicians surveyed reported that they intended to participate in the Medicare and Medicaid EHR incentive payment programs, which were created under the American Recovery and Reinvestment Act of 2009. Thus far, those two programs, plus Medicare Advantage, have paid out more than $6.8 billion to nearly 330,000 physicians and other eligible professionals, or about 63% of the 527,000 who are eligible to participate.

Follow Joseph Conn on Twitter: @MHJConn


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