Despite growth, EHR adoption seen as uneven

There has been rapid growth in physician implementation of electronic health records, but adoption has been uneven, and the pace will have to accelerate for most nonusers to avoid the penalties that will start being assessed in 2015, according to a letter to the editor published in the New England Journal of Medicine.

The letter gives a snapshot of what the meaningful-use landscape looks like as far as adoption rates and vendor market share. The letter was written by Boston-area researchers at Boston University School of Medicine, Brigham and Women's Hospital and Harvard Medical School, as well as researchers from the University of Texas Health Science Center at Houston, using CMS data from between April 2011 and May 2012. (They did not include attestations by hospitals and nonphysicians in their calculations.)

As of May 2012, they calculated that 12% of physicians had attested to meeting meaningful-use requirements (62,226 out of 509,328), including 9.8% of specialists and 17.8% of primary-care physicians. Family medicine was the specialty with the most attestations, 14,222.

The rate of meeting meaningful-use requirements was geographically uneven. The median attestation rate by state was 7.7%. Alaska had the lowest attestation rate, 1.9%; and North Dakota had the highest, 24.2%; according to the letter.

“Although these data suggest rapid growth in the number of providers achieving meaningful use, this pace must accelerate for most eligible professionals to avoid penalties in 2015,” the authors wrote. “Barriers to EHR adoption and meaningful use include cost, lack of knowledge, workflow challenges and lack of interoperability.”

The researchers counted 310 different EHR vendors being used by the attesting doctors, but the top five vendors—Epic, Allscripts, eClinicalWorks, GE Healthcare and NextGen—accounted for 58.5% of attestations.

The authors noted that requirements for the next phases of the meaningful-use program will become increasingly difficult to meet and that the “downstream effects of meaningful use” on quality, safety and efficiency are still not known.

To ensure the effectiveness of the program, they conclude more physicians still need to adopt EHRs, more research needs to be done and the functionality of clinical decision-support systems needs to be increased.