EHRs Become More Popular With Small Medical Practices

12 EHR Vendors That Stand Out

Small medical practices are starting to use electronic health records (EHRs) at a faster rate than medium-size and large groups, according to a new survey of 240,000 U.S. practice sites by SK&A, a division of Cegedim. But the total EHR penetration is still far lower in small practices than in bigger groups--37% for soloists, for example, versus 77% in the largest practices.

The firm's telephone survey found that 46% of all respondents had EHRs in January 2012, compared to 40% in January 2011. That's roughly comparable to what a recent Medical Group Management Association (MGMA) survey of its members discovered. According to MGMA, 51% of groups of three or more physicians are using some kind of EHR.

The biggest difference between the two surveys is that SK&A queried the one- and two-doctor practices that MGMA missed. SK&A reports that 37% of sites that include only one doctor had an EHR in January 2012, compared to 31% in January 2011. Similarly the adoption rate in two-doctor sites jumped from 42% to 47%, and in three-doctor locations from 51% to 55%.

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In contrast, EHR adoption in sites with six to 10 doctors advanced only from 63% to 65%. It increased from 72% to 74% in offices with 11 to 25 physicians, and from 76% to 77% in groups of 26 or more doctors.

To put this in perspective, 2011 was the first year in which providers could attest to Meaningful Use and receive government incentive payments. Although that partly explains the overall jump in EHR adoption, it also appears that penetration in larger groups is leveling off, while adoption in small practices is soaring.

That doesn't surprise Gray Tuttle, a practice management consultant in Lansing, Mich. Tuttle told InformationWeek Healthcare that he's seen a significant jump in EHR adoption by practices of four physicians and fewer. "The systems are more nimble, not as complex and easier to implement, and these doctors will try them," he said. "There are a number of really good applications for that practice setting that have worked. Clients of mine have implemented these EHRs and are using them."

Nearly all of the small practices that have adopted the technology are using cloud-based EHRs such as those of Allscripts and eClinicalWorks, Tuttle said. Onsite computer hardware and software are technically difficult to operate and maintain, he pointed out, "so the hosted approach works better" for small practices.

Another reason why small groups are starting to come to the table, said Jack Schember, SK&A's director of marketing, is that the government-funded regional extension centers (RECs) are helping them with EHR selection, training, and implementation. "That has played a key role in the adoption," he told InformationWeek Healthcare.

Sites owned by hospitals and healthcare systems had much higher rates of EHR adoption than independently owned offices did, showing the role that deep pockets and existing IT infrastructure play. Moreover, hospital-based or affiliated specialties such as dialysis, pathology, nuclear medicine, and radiology had the highest rate of EHR penetration.

Of the physician sites that had not yet implemented EHRs, 71% still didn't have a time frame for doing so last July, according to an earlier SK&A survey. That does not mean they were uninterested in the Meaningful Use incentive program, Schember noted. But it's telling that about a fifth of the respondents had never heard of the program at that time.

In the new SK&A report, the proportion of physician sites that had an EHR with basic functionality was much lower than the percentage that had any kind of EHR. A third of the sample said they used electronic notes; 31% prescribed electronically; 32% ordered or received results from lab and imaging tests online; and 26% did all of the above. The findings track with the results of surveys by MGMA and the Centers for Disease Control and Prevention (CDC).

The adoption rate also varies by geographical region. The North, South, and West are a few points ahead of the East for reasons Schember could not explain.

The top five states for EHR adoption this year are Minnesota, Utah, North Dakota, Oregon, and South Dakota. The bottom five states are California, New York, Maryland, Louisiana, and New Jersey.

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