This is the second recent survey to show that the vast majority of physicians now have EHRs. In the earlier survey, Medscape, an online continuing medical education company, found that three-quarters of 21,200 physician respondents had EHRs.
Of the CapSite respondents, 39% were employed by hospitals and 61% were in freestanding, non-hospital-owned groups. The differences between the two types of practices were illuminating.
Of the respondents in hospital groups, 48% said they had attested to Meaningful Use, compared to just 40% of doctors in freestanding practices. Mark Anderson, a health IT consultant based in Montgomery, Tex., said that reflects the impact of Epic, which is used by many hospital groups and practices with more than 250 physicians. Through July, he said, Epic users dominated the ranks of doctors who had attested.
Another big difference between the hospital-owned and freestanding groups is that 83% of the former but only 47% of the latter had plans to join either a private or a public health information exchange (HIE). Overall, the survey found, 60% of respondents planned to join an HIE.
"I think the hospitals are getting engaged with HIEs more because they have to send information to the doctors, including lab results and operative and consult reports," Anderson said. "So they understand the value of an HIE. The average doctor out there [in a freestanding practice] doesn't know what an HIE does. They're getting data, not necessarily sending data. They don't understand the value of exchanging data with their colleagues."
[ Looking for a PACS platform to replace an outdated system? See 9 Must-See Picture Archiving/Communication Systems. ]
Breaking down market share for ambulatory care EHRs, CapSite found that the largest number of respondents (17%) used Epic, followed by Allscripts (15%), eClinicalWorks (9%), NextGen (7%), and GE (6%). Big hospital information system (HIS) vendors like Cerner, Meditech, McKesson and Siemens all had much smaller shares of the ambulatory care market.
Epic is a health information system (HIS) vendor, but its ambulatory care EHR was not an outgrowth of or adjunct to its inpatient system. Similarly, while Allscripts now encompasses the former Eclipsys hospital EHR, the company was originally an ambulatory care EHR vendor. The other HIS vendors, Anderson noted, either created ambulatory care EHRs as an extension of their inpatient systems or acquired ambulatory care EHRs (e.g., McKesson and Practice Partner, Meditech and LSS) without doing much to develop them to meet the needs of office-based physicians.
About a fifth of the respondents planned to buy new EHRs, and another 20% intended to upgrade their current platform. Nearly twice as many (24%) freestanding groups planned to buy a new EHR as did hospital-owned groups (13%). The biggest reasons cited were to increase efficiency and quality. Only 13% of respondents said their motive was to get government EHR incentives, although that's clearly what's driving the current surge in EHR adoption.
Only 13% of respondents planned to buy a new practice management system (PMS), and 14% intended to upgrade their current system. Significantly more freestanding practices than hospital-owned groups were making any kind of change in their PMS--a fact that Anderson attributes to the fact that it's much harder to replace a PMS in a large hospital group than in a small or medium-sized independent practice.
The top five vendors of ambulatory PMS systems, according to the CapSite poll, are Allscripts (16%), Epic (10%), GE (8%), eClinicalWorks (7%), and NextGen (7%). All of these vendors offer integrated PM/EHR systems, but half of the respondents said they wouldn't replace their current PM system with an integrated system, and just 21% said they'd consider doing that. 29% were unsure.
The latter finding, Anderson said, indicates that many of the groups that responded to CapSite's survey were quite large. "I'm seeing 83% of small practices switching out to an integrated system. But groups of over 25 doctors are not switching. So those numbers match what I see in the over-25 and over-50 groups."
Larger groups are reluctant to move to integrated systems--despite their supposedly greater efficiency--because of the difficulty of transitioning from one billing system to another. "You can't move all the data over from your old PM system to the new one," Anderson noted. So for a period, a large group has to run two systems at the same time, with all the manual rework that entails. And it's very costly, he added, to retrain 50 billers to work on a new system.
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