While there were more returns reported Tuesday than a month ago, the latest results from a federally supported study of physician usage of electronic health-record systems showed no change in overall physician adoption of EHR systems. Meanwhile, new breakouts on practice size indicate a market failure at the small-practice level despite nearly four years of ballyhoo by the federal government that EHRs will reduce healthcare costs and improve the quality of care.
Catherine DesRoches, an assistant in health policy at the Massachusetts General Hospital Institute for Health Policy, Boston, authored the updated survey presentation Tuesday before the Electronic Health Records Workgroup of the American Health Information Community. Her colleague, Institute Director David Blumenthal, made a similar presentation to the full AHIC last month based on early returns from the survey and a data sample of more than 1,500 respondents, about a third smaller than the 2,458 responses on which DesRoches' report was based.
Here are the highlights, based on what was defined in her report as a "minimally functional" EHRone that can capture clinical notes, record orders for prescriptions, lab tests and radiological exams, and view lab and imaging results:
Just 14% of physicians responding had one of these basic EHRs, according to DesRoches, unchanged from Blumenthal's report of Jan. 24 with the smaller sample.
That number was buoyed by much higher adoption rates in larger groups (for example, groups of 10 or more physicians had a 36% adoption rate) and multispecialty groups (30%). Only 10% of single-specialty groups has an EHR.
Just 6% of solo practitioners surveyed had one of these minimally effective EHRs, and only 9% of physicians in dual practice had such a system.
In groups of three or four physicians, and five to nine physicians, the adoption rates were 12% and 19%, respectively. And yet these paltry numbers actually mask a more serious problem. There are 308,900 office-based physicians who are not federal employees, who are not working for a hospital's ambulatory-care program, and who are not radiologists, anesthesiologists or pathologists, according to the latest numbers from Catharine Burt, acting chief of the ambulatory- and hospital-care statistics branch at the National Center for Health Statistics.
Based on the 2005-06 annual average, nearly 37% of those 308,900 physicians are in solo practice (or about 113,675), and roughly another 12% (37,377) are in partnership with another physician. Combined, those two groups account for nearly half of all office-based physicians (almost 49%). The NCHS has been measuring some form of physician EHR adoption since 2001 and the no-man's land of low levels of penetration at the small-office level mirrors those in the Massachusetts General survey, Burt said.
"The increases that we see occurring is not in the solo docs, it's in the bigger practices, the seriously bigger practices," Burt said. "They seem to be coming right along."
Collaborating with Massachusetts General on the survey is the Harvard School of Public Health, George Washington University and RTI International.
DesRoches' survey presentation did not include updated numbers on adoption rates for a 17-function, "fully functional" EHR, which surveyors are also trying to measure. Last month, Blumenthal pegged that rate at a miniscule 4%.
DesRoches says the surveyors haven't done a lot of slicing and dicing of the data yet because they want to have a full and final sample first. Field work on the survey is expected to continue for a couple more weeks, according to DesRoches. But the low adoption by small groups "didn't surprise me."
"They don't have the resources," DesRoches said. "They don't have an IT person to go out and investigate all of the systems. And they are concerned that the (learning) time to use one of these systems would slow them down as well. In our preliminary work for this a couple of years ago, it seemed that all of the barriers are ramped up for the small practices."
The two survey counterparts, one of which was to be filled out by a physician, the other by the person "most knowledgeable about the practice characteristics and HIT use," did not ask how long it might take for the nation to reach full adoption of EHRs, but the buzz in some preliminary meetings wasn't good, DesRoches said.
"I haven't heard anything other than what we heard in our focus groupsthat this is going to take a lot longer than 2014," she said.
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