Family Physicians Lead In EHR Adoption

9 Mobile EHRs Compete For Doctors' Attention

More than two-thirds of family physicians (FPs) had adopted electronic health records by 2011, and the adoption rate is likely to surpass 80% this year, according to a new study in the Annals of Family Medicine.

The data came from the American Board of Family Medicine (ABFM), which surveys all candidates applying for its maintenance of certification exam, and the National Ambulatory Medical Care Survey (NAMCS). The results of the two surveys showed EHR adoption among family doctors doubled to 68% between 2005 and 2011.

However, adoption varied significantly by state. The ABFM data showed rates that ranged from 47% in North Dakota to 95% in Utah. On the NAMCS survey, FP adoption rates ranged from 44% in North Carolina to 87% in Hawaii.

Among the reasons for state-level variations, the researchers said, are differences in state support for health IT adoption, variations in the penetration of HMOs and integrated delivery systems, and the prevalence of large physician practices.

[ Are your patients engaged in their own care? See 7 Portals Powering Patient Engagement. ]

Interestingly, rural areas did not have significantly lower adoption rates than urban areas, Andrew Bazemore, MD, director of the Robert Graham Center of the American Academy of Family Physicians (AAFP), told InformationWeek Healthcare. AAFP publishes Annals of Family Medicine. However, he added, there was somewhat lower adoption in areas with high rates of poverty.

As has been the case for several years, FPs continued to outpace other physician specialties in their adoption of EHRs. According to the NAMCS, 57% of all office-based physicians had EHRs in 2011, 11 percentage points below the FP figure in the Annals of Family Medicine study.

Bazemore suggested several reasons for this disparity. First, the AAFP's Future of Family Medicine report in 2004 emphasized the importance of health IT in rebuilding family medicine. "It was the center of what we thought we needed to do to transform ourselves, even 5 or 10 years ago."

In addition, he noted, the AAFP's Center for Health IT has been driving that message home to members for the past decade. No other specialty society has had a similar center for that long, he stated. The health IT regional extension centers born of the HITECH Act also helped boost EHR adoption among family practices, he said.

However, when the HITECH Act -- which authorized the Meaningful Use EHR incentive program -- came along in 2009, "family physicians were already ahead [in EHR adoption]," Bazemore pointed out. "We didn't find that the HITECH Act changed the trajectory of adoption for family physicians from that time forward."

One reason is the nature of family medicine, he added. "Family physicians had a lot of good reasons to walk toward EHRs earlier, based on the nature of their practice, its breadth and the way they approach medicine."

Bazemore admitted that the study did not provide any insight into what kind of EHRs family physicians were using or what they were using them for. The question asked on both the NAMCS and ABM surveys, he said, was "woefully blunt. It just asked, 'Do you use an EHR in your office?' You know that that ranges from the simplest practice management software or registry to something that's infinitely more complex."

The NAMCS survey, however, found that in 2011, about a third of physicians had an EHR that met the government's criteria for a "basic system." This is a system that includes most of the capabilities required for Meaningful Use stage 1.

Through the end of 2012, about 20,000 family physicians had received Medicare incentive payments, meaning they had attested to Meaningful Use, according to the Centers for Medicare and Medicaid Services (CMS). Some other FPs had received Medicaid incentives, for which they didn't have to attest to Meaningful Use in the first year.

The researchers estimated that EHR adoption among FPs would hit 80% this year, based on extrapolation of the trend line from 2005-2011, Bazemore noted. The EHR adoption rate might drop after that, he said, because not all of the "laggards" will implement systems. However, he added, the CMS penalties for not showing Meaningful Use by 2015 would probably encourage most physicians to adopt.

Moreover, he pointed out, the new forms of care delivery that are emerging assume that doctors have EHRs. "So you can be penalized by a loss of business if you don't adopt."

Federal Meaningful Use Stage 2 requirements will make your medical organization more competitive -- if they don't drive you off the deep end. Also in the new, all-digital Meaningful Mania Part 2 issue of InformationWeek Healthcare: As a nation, we're falling short of the goal of boosting efficiency and saving money with health IT. (Free with registration.)