Meaningful use of EHRs by doctors fell in 2014

Participation by office-based physicians in the electronic health-record incentive payment program waned significantly in 2014, the program's fourth year, as clinicians faced system upgrades and tougher requirements.

The number of physicians and other eligible professionals in ambulatory care who attested to having met the requirements of the multibillion-dollar federal program dropped by 12% last year compared with 2013 numbers, based on federal data for the type of EHR system these providers most commonly use.

Meanwhile, less than a third of the office-based providers using complete EHRs managed to step up to the program's more stringent Stage 2 requirements in 2014.

Epic Systems Corp., the Verona, Wis.-based EHR developer, had by far the largest number of physicians and other customers of its complete EHR system used in an ambulatory-care setting who met Stage 2 meaningful-use requirements last year.

Some 36,350 physicians and other eligible professionals used Epic's software to meet Stage 2 requirements in 2014. They accounted for 57.5% of the 63,288 ambulatory-care providers able to attest at Stage 2 in that category, according to a mashup of databases kept by the CMS and the Office of the National Coordinator for Health Information Technology at HHS.

Rounding out the top five developers of complete EHRs used by ambulatory providers meeting Stage 2 requirements were eClinicalWorks, with 10.1% of providers; Athenahealth, 7.1%; Allscripts, 5.2%; and Practice Fusion, 2.9%.

There were 474 vendors with at least one customer in the program and 136 developers had at least one customer use their software to clear Stage 2. But the top 10 vendors accounted for 91% of all Stage 2 meaningful users.

So far, the federal EHR incentive payment program, created under the HITECH provisions of the American Recovery and Reinvestment Act of 2009, has paid $12.5 billion to physicians and other eligible professionals to buy and meaningfully use EHRs, according to the latest program update from the CMS. (Hospitals have received nearly $18.6 billion.)

In May 2014, realizing the program was in trouble, the CMS delayed for a year the compliance date by which certain early participants in the program meet Stage 2 requirements.

The relatively high percentage of providers—62%—still stuck on Stage 1 in the fourth full year of the program bears out the wisdom of the CMS' Stage 2 compliance extension.

The latest data tracks with an analysis done earlier this year by the American Academy of Family Physicians, according to Dr. Steven Waldren, director of the AAFP's Alliance for eHealth Innovation.

Waldren said the number of family physicians who attested to meaningful use in 2014 fell nearly 40% to about 23,500 practitioners compared with 2013. Physicians specializing in internal medicine experienced a similar drop-off, he said.

Waldren said he sees three reasons for the decreased participation in 2014.

“One, you had to upgrade your system to do Stage 2, to a 2014 Edition certified product,” Waldren said. “You had docs saying: I have to spend $10,000 to do an upgrade and then I have to do the criteria, and I'm not going to do it.”

Then, among those who made a decision to upgrade, some had trouble getting the system delivered by their vendors and installed in their practices, Waldren said.

“Finally, I think some of the big reasons a lot of people aren't doing Stage 2 are the patient-engagement requirements,” Waldren said.

Under current Stage 2 meaningful-use rules, physicians and other “eligible professionals” must attest that 5% of their patients have used their EHR to electronically view, download or transfer their records. The rule is nettlesome to some providers who say they're being made responsible, and could be penalized, for a lack of patient conduct beyond their control.

The CMS has issued a proposed rule that would reduce that requirement to merely demonstrating that such downloads were possible by attesting that a single patient had done it. But no final rule has been issued, so the 5% requirement is still in force.

“For that,” Waldren said, “you'll see a lot of them (physicians) switching over to Stage 1 or dropping out.”

The CMS is now working on Stage 3 rules, and many provider and IT organizations, including the AAFP, have asked CMS to hit the pause button.

“We're probably thinking that even Stage 2 needs to be delayed because of this drop-off” in physician participation, Waldren said.