Physician EHR Adoption Varies With Age, Specialty, Affiliation
Study suggests that older, small-practice, specialist, and independent doctors are less likely to have EHRs than are other physicians.
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Doctors in small practices, older physicians, and non-primary care specialists continue to lag other categories of physicians in adoption of electronic health records (EHRs), according to a new study in Health Affairs. Moreover, the study points out, the use of "basic" EHRs--systems containing features that many experts believe are conducive to quality improvement--remains low among all types of doctors in different practice settings.
Between 2002 and 2011, the researchers found, the percentage of physicians who said they had any type of EHR increased from 18% to 55%. During that period, primary care doctors adopted EHRs at a faster rate than specialists. By 2011, the gap between primary care doctors' and specialists' adoption of EHRs had widened: 59% of generalists had any kind of EHR vs. 50% of specialists.
Similarly, in 2011 40% of primary care physicians had basic EHRs, compared to 31% of specialists. Overall, about a third of physicians had basic EHRs, which allow them to record information on patient demographics, diagnoses, and medications, store clinical notes, view lab and imaging results, and prescribe electronically.
Jane E. Sisk, a study coauthor and a scholar-in-residence at the Institute of Medicine, told InformationWeek Healthcare that specialists' lower adoption rate was partly related to "the limitations in the EHR systems on the market," which may not offer the features that some specialists require.
The study also found a growing divergence between doctors who were 45 or younger and physicians who were 55 or older, both in overall EHR adoption and the use of basic EHRs. Midsize and large practices also acquired EHRs at a faster rate than small practices did, although there was a big jump in the percentage of one- and two-doctor practices that had EHRs from 2010 to 2011, Sisk said. Much of that movement, she added, may have resulted from the government's incentives for Meaningful Use of EHRs.
Not surprisingly, practices owned by healthcare systems and other large organizations were more likely to have an EHR than private practices were, and that difference also widened during the study period. Adoption of basic EHRs was higher in the Midwest and the West, where large group practices are numerous, than in the South and the Northeast, where small private practices remain the norm.
Sisk said she does not believe that the slower rates of adoption by older, small-practice, independent, and specialist physicians means that EHR implementation will plateau in any of those categories. Many older physicians will retire, she pointed out, and the number of physicians in solo and two-doctor practices--now about 40% of the total--will continue to shrink as more and more of those doctors go to work for hospitals and other healthcare organizations. "So I don't see there's necessarily any plateau or wall that any one group of physicians would hit."
Nevertheless, she pointed out, the low adoption rate of basic EHRs creates a significant challenge for the EHR incentive program. EHRs certified for Meaningful Use must include not only the basic EHR functions listed above, but also a few others, such as decision support and interoperability features. So if only a third of physicians have even basic EHRs, far fewer doctors have certified systems capable of showing Meaningful Use.
An accompanying study in Health Affairs supports this conclusion. That study reveals that, while 51% of physicians intended to apply for the EHR incentives in 2011, only 11% also had the "computerized capabilities" to meet the 10 core criteria of Meaningful Use.
"It's a challenge to the federal schedule [for awarding incentive funds]," she said. "These results indicate that it would be important to continue monitoring this situation and see how people are doing with Meaningful Use stage 1 and when it's realistic to increase those requirements and go to stage 2."
Policymakers should also consider expanding the health IT regional extension centers and other federal programs that help physicians implement EHRs, she added. Among other things, she said, the government might broaden its technical assistance programs to include non-primary-care specialists.
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