EHR Adoption Grows Rapidly in Office-Based Physician Groups

Miriam E. Tucker

July 10, 2013

Washington, DC — The adoption of electronic health records (EHRs) by physicians grew substantially between 2010 and 2012, with the most rapid growth occurring among physician groups that have until recently been lagging behind.

The findings were among those presented in 3 articles published online July 9 in Health Affairs and presented at a briefing held here.

"As providers become increasingly responsible for the costs and quality of care, having robust information systems that allow them to manage care more effectively will be critical," said Chun-Ju Hsiao, PhD, senior service fellow at the National Center for Health Statistics, Hyattsville, Maryland.

The Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 authorized nearly $30 billion for the adoption of health information technology throughout the US healthcare system, with substantial resources directed toward providing technical assistance. In 2011, the Centers for Medicare and Medicaid Services initiated incentive payments to eligible providers who adopt and "meaningfully use" specific EHR capabilities.

To determine the effect of the incentives, Dr. Hsiao and colleagues analyzed data from the National Ambulatory Medical Care Survey–Electronic Health Records Survey of more than 9000 office-based physicians for 2010 through 2012.

Over the course of 2 years, there was a 57% increase in the adoption of any EHR by office-based physicians and a 34% rise in the adoption of "basic" EHRs, which includes capabilities for ordering prescriptions, recording patient history and demographic information, recording a list of the patient's medications and allergies, recording patient problem lists, recording clinical notes, viewing laboratory results, and viewing imaging results.

Before the incentives, adoption of EHR by office-based physicians had been increasing by just 4% per year.

Use of any EHR rose from 51% to 72%, and use of EHRs that included all 7 capabilities rose from 25% to 40%. "Two years after the implementation of HITECH, we found continuing growth in EHR adoption and use of these capabilities," Dr. Hsiao said.

Multivariate analysis showed that basic EHR adoption increased substantially among physician groups with historically low adoption rates, including those aged 65 and older (from 16.5% to 33.3%), solo practitioners (from 11.3% to 25.6%), and those working in community health centers (from 13.5% to 32.3%). Adoption also rose among physicians working in rural areas (from 30.8% to 43.5%).

There were also significant increases in the adoption of capabilities related to selected stage 1 core criteria for "meaningful use" of EHRs that were not part of basic EHR systems, including sending prescriptions to the pharmacy electronically, providing warnings for drug interactions, and providing reminders for guideline-based care.

In another multivariate analysis, routine use of EHR capabilities was higher for larger practices and those owned by health maintenance organizations or other healthcare organizations.

"Our findings on the increased adoption and the narrowing of gaps in each of the physician groups are consistent with the proposed positive effect of incentives and technical assistance on physicians' adoption and use of health information technology," Dr. Hsiao said.

"Although the US healthcare system still faces important challenges, rapid growth in the [information technology] infrastructure may create a platform for delivery of high-quality, efficient care," she concluded.

Dr. Hsiao has disclosed no relevant financial relationships.

Health Aff. Published online July 9, 2013. "From Health Affairs: Trends in the Adoption of Health Information Technology."


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