Meaningful Use Doesn't Drive Doctors' EHR Selection

Seventy-two percent of office-based physicians now use electronic health record (EHR) systems, a 26% increase from the 2011 estimate (57%), according to preliminary data from the National Ambulatory Medical Care Survey (NAMCS), conducted by the National Center for Health Statistics (NCHS).

Only 40% of office-based physicians reported having a system that met the criteria for a "basic" EHR, compared to 34% in 2011. According to NCHS, a basic EHR system includes the following functionalities: patient history and demographics, patient problem lists, physician clinical notes, comprehensive list of patients' medications and allergies, computerized orders for prescriptions, and the ability to view lab and imaging results electronically.

The government health IT incentive program requires all of this basic EHR functionality, except for clinical notes, to show Meaningful Use and gain federal incentive payments. Yet adoption of basic EHRs lagged that of EHRs, basic or otherwise, in 2012.

Jason Mitchell, MD, assistant director of the Center for Health IT at the American Academy of Family Physicians (AAFP), told InformationWeek Healthcare that he found this puzzling. While there's no doubt that Meaningful Use has driven much of the increase in EHR use, he said, it seems strange that so many physicians would buy and implement EHRs that could not be used to show Meaningful Use, he said.

NAMCS also found that while two-thirds of respondent doctors said they had applied or intended to apply for Medicare or Medicaid EHR incentives, just 27% of those doctors said their EHRs had the capabilities to meet most of the core Meaningful Use criteria. Some of the respondents probably didn't know everything their EHRs could do, said Mitchell. But the data suggest that many physicians had EHRs not certified for Meaningful Use.

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Based on the data that the AAFP has collected since 2005, Mitchell said that it doesn't appear Meaningful Use has been the driving force for acquiring EHRs among family physicians. "Family doctors have been pressed financially for some time, and were looking for tools such as EHRs to make their practices more effective and efficient," noted Mitchell. Last year, when eligible professionals (EPs) started attesting to Meaningful Use and receiving incentives, 63% of family physicians already had EHRs, and the percentage is probably around 75% now, he said.

The number of doctors attesting to Meaningful Use has risen sharply this year. Yet Mitchell cited the gap between the number of provider registrations and attestations as evidence of some worrisome problems in the program. As of October, he pointed out, 225,000 Medicare eligible providers (EPs) had registered, but only 88,000 had attested.

Many family physicians have stopped trying to get EHR incentives, he said, "because the hoops they have to jump through are so onerous." Quality reporting is part of the problem, he said, and there are also barriers to providing visit summaries and doing medication reconciliations and security reviews. For example, he noted, physicians don't necessarily complete their documentation during a visit. If they can't provide a visit summary to patients before they leave, the burden falls on their office to send patients the summaries in the next few business days. And this is only one of many Meaningful Use criteria they must meet.

The NCMS report also shows large geographical variations in EHR adoption and the intentions of EPs to apply for government incentives. For example, the percentage of physicians using any kind of EHR ranged from 54% in New Jersey to 89% in Massachusetts. The geographical range in the percentage of physicians who used a basic system was even wider: 22% in the District of Columbia, vs. 71% in Wisconsin.

The AAFP has also seen a relationship between EHR adoption and geographical location, said Mitchell. Some of it has to do with the differences between rural and metropolitan providers, he said. But the low rate of adoption in densely populated New Jersey shows that's not the only factor. New Jersey was long dominated by small practices. But Meaningful Use incentives have been most avidly sought by large groups, Mitchell noted.