Use of Electronic Health Record Systems in Office-Based Practices

The use of electronic health record (EHR) systems in office-based physician practices continues to rise, but the prevalence of these systems varies significantly by state. These are just a few of the conclusions drawn from a recent data brief from the National Center for Health Statistics (NCHS) that examines EHR trends and physicians intent to participate in EHR incentive programs.

Physicians who are meaningfully using certified EHRs are elgible to receive incentive payments through Medicare and Medicaid programs as part of the 2009 Health Information Technology for Economic and Clinical Health Act, or the HITECH Act. In 2011 and 2012, the incentive programs, which were created to promote the adoption of EHR systems, required physicians to demonstrate 15 of the Stage 1 Core Set objectives for meaningful use and 5 of 10 Menu Set objectives.

This report examined physicians’ abilities to meet 13 of the Stage 1 Core Set objectives, along with general EHR use trends and differences in EHR use among states. The report was prepared using data from the 2012 National Ambulatory Medical Care Survey of physicians, along with survey data from previous years.

According to the survey findings, preliminary estimates showed that nearly three-quarters (72%) of office-based physicians used some type of electronic medical record (EMR) or EHR in 2012. This figure is up from an estimated 57% in 2011.

The percentage of office-based physicians who are using EHR systems that meet the criteria for a basic system is also on the rise. Basic EHR systems must include patient history and demographics, patient problem lists, physician clinical notes, comprehensive lists of patients' medications and allergies, the ability to view laboratory and imaging results electronically, and the ability to computerize prescriptions. According to the survey, 40% of physicians in 2012 had systems that met the basic system requirements compared with 34% in 2011.

The prevalence and adoption of EHR systems varied by state and, according to the report, the percentage of physicians using any EHR system ranged from 54% in New Jersey to 89% in Massachusetts. Similarly, adoption of EHR systems that met the criteria for basic systems also varied by location and ranged from 22% in the District of Columbia to 71% in Wisconsin.

Not only is the use of EHR systems on the rise, but a growing number of physicians also plan to participate in Medicare or Medicaid incentive programs. According to the survey, 66% of physicians in 2012 had either already applied or intended to apply for the Medicare or Medicaid incentive program, an increase from 52% in 2011. The intent to participate in the programs varied based on state and was found to be as low as 48% in Alaska and as high as 85% in Delaware.

As part of the report, the NCHS also examined physicians’ abilities to meet the core objectives required to show meaningful use in the incentive programs. These core objectives included EHR capabilities such as drug interaction checks, generating prescriptions electronically, maintaining an active medication and up-to-date problem list, and having an electronic copy of health information. The survey found that in 2012, 27% of the physicians who planned to participate in the incentive programs had computerized systems that were capable of supporting 13 of the Stage 1 Core Set objectives. Authors of the report noted, however, that this figure is an overestimate of the percentage that could meet the requirements since it only assesses 13 of the 15 objectives and does not assess office-based physicians' abilities to meet the Menu Set objectives.