Both surveys were done at the same time, and both included about the same number of American physicians. Accenture polled 3,700 physicians in eight countries, including 500 U.S. doctors; Deloitte's survey involved just over 500 randomly selected, responding physicians from the AMA Masterfile. But Deloitte asked about EHRs that were qualified for Meaningful Use -- i.e., systems that had basic capabilities -- whereas Accenture asked about any kind of EHR.
Deloitte found that only half of physicians aged 60 or older had MU-ready EHRs. In comparison, 71% of doctors who were 25-39 years old had such EHRs; so did 71% of those aged 40-49 and 67% of those aged 50-59.
Physicians in small and solo practices were also less likely to have EHRs than those in larger groups and healthcare systems. Only 31% of soloists had EHRs, vs. 62% in practices of two to nine physicians and 82% of those employing 10 or more doctors. Among solo practitioners who do not have EHRs, 71% do not plan to acquire one; that was also true for 32% of doctors in midsized practices and 28% of those in large groups that do not yet have an EHR.
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The biggest reasons for not getting an EHR, the survey found, were the upfront investment, ongoing maintenance costs and the increased complexity of delivering care with an EHR.
Ken Bowden, a practice management consultant in Pittsfield, Mass., said that the EHR resisters fall into one of two camps. "One group hides their heads and says, 'Go away.' And then there are the ones who don't think it's worth it. Because even though the government is reimbursing them up to $60,000, most systems cost at least that much, and they lose a year's worth of income in the implementation of it. If they have less than 10 years left to retirement, I tell them, 'don't do it.'"
Some experts, Bowden noted, recommend that doctors cut their patient schedules in half for the first six months after they introduce an EHR. "None of my clients went to half a schedule, but they did a lot less visits than they did in the past [after getting an EHR]. And it takes a year-and-a-half to two years to get back to where you were, if you ever get back. Some of those systems slow you down so much that you never regain the productivity."
Another physician survey by AmericanEHR and the American College of Physicians supports Bowden's point. According to that 2012 poll, 32% of doctors who used EHRs said that they hadn't recovered their productivity. Only 20% said that in a similar survey in 2010.
Bowden admitted that if physicians were better trained on EHRs and had tech-savvy support staff, "they'd cut their downtime in half." That's proved by the primary care doctors who received help from the regional extension center in Massachusetts. "I'm not hearing any horror stories from them," he said. But the usability of EHRs also matters, and many of his clients "go on the cheap" when they buy EHRs, he added.
The Deloitte survey also had these notable findings:
-- 73% of physicians believe that health IT will improve the quality of care in the long term. Younger doctors and those in larger practices were more likely to say that.
-- 71% of physicians believe that the promise of health IT reducing costs is inflated and that the technology will drive up, not cut, costs. That position was held more widely among solo physicians and those not employed in practices belonging to accountable care organizations.
-- A third of doctors communicate with consumers using e-mail or texts.
-- 15% of physicians use telemedicine for follow-up or diagnostic visits with patients.
-- 14% of respondents allow consumers to schedule visits and access test results and medical records via mobile devices.
-- Nearly six in 10 physicians don't employ mobile health technologies -- tablets or smartphones -- for clinical purposes.
Of the non-users of mobile technology, 44% attribute their reluctance to the lack of cooperation in their workplace, 29% to concerns about patient privacy, and 26% to a lack of suitable apps and programs.