EHR Divide Is Widening Among Physicians, CDC Says

May 22, 2014

Electronic health record (EHR) systems in physician practices have gone from novelty to norm, but a new study from the Centers for Disease Control and Prevention (CDC) points to a growing digital divide between group practices and soloists.

In 2012, almost 72% of office-based physicians used some sort of EHR system compared with 34.8% in 2007, according to a survey conducted by the CDC's National Center for Health Statistics (NCHS). However, not all EHRs are created equal. About 40% of physicians in 2012 used software that met the requirements of what the NCHS dubs a basic system, while only 23.5% had software qualifying as fully functional — able to send a prescription to a pharmacy electronically, for example, or remind clinicians of needed screening tests.

Although in the minority in 2012, fully functional EHR systems have nevertheless come a long way since 2007, when only 3.8% of physicians reported using them to the NCHS. However, their rate of adoption in medicine hasn't been uniform. In 2007, 4.7% of primary care physicians and 2.8% of their specialist colleagues had a fully functional system — "no significant gap" in eyes of the NCHS. However, by 2012, there was a gap of 8.5 percentage points between primary care adopters (27.9%) and specialist adopters (19.4%).

The divergence is even greater for soloists versus physicians in medical practices of 11 or more. The percentage of soloists with fully functional systems increased from 1.6% in 2007 to 11.9% in 2012. For physicians in groups of 11 or more, that percentage rose from 12% to 42.5%. The gap between the 2 groups increased from 10.4 percentage points to 30.6.

Independent practices also are falling behind the adoption pace of practices controlled by nonphysicians. In 2007, 2.7% of practices owned by physicians had a fully functional EHR compared with 5.9% of practices owned by hospitals, academic medical centers, and other corporate owners — a spread of 3.8 percentage points. By 2012, the spread between these 2 categories had swelled to 13.6 percentage points. Meanwhile, the percentage of physicians in health maintenance organizations (HMOs) who charted with a top-tier system jumped from 27.1% to 80.6%.

Experts chalk up the slower growth of EHR adoption among soloists and independent practices mostly to a relative lack of cash and hi-tech expertise. Larger groups, particularly those owned by big healthcare, are more likely to have the resources needed to switch from paper to electronic records.

The NCHS noted that adoption of EHR technology from 2007 to 2012 generally followed these patterns — primary care more than specialist, large groups more than small groups, HMO ownership more than independent practice — regardless of whether the system was fully functional or not. In addition, the agency said that adoption skewed toward younger physicians compared with older ones, and physicians in multispecialty practices compared with single-specialty practices.

Not Much Light Shed on Meaningful-Use Trends

The time period covered in the NCHS survey includes the 2011 debut of the federal incentive program for the "meaningful use" of EHRs. The prospect of a 5-figure Medicaid or Medicare bonus — or a Medicare penalty for flunking meaningful use — helped account for the rapid growth in EHR adoption from 2007 to 2012.

Attention understandably has turned to the number and percentage of physicians participating in the federal program, operated by the Centers for Medicare & Medicaid Services. Besides being 2 years out of date, the NCHS data does not say anything conclusive about meaningful use. NCHS explained that what it calls a fully functional EHR system does not necessarily equal a system that would allow someone to achieve meaningful use. The agency reported that in 2012, only 19.5% of physicians had systems that would support 13 of the original 15 core objectives in Stage 1 of the incentive program. The 13 include electronically transmitting prescriptions, maintaining an active medication list, and checking for drug-drug and drug-allergy interactions.

NCHS did not query physicians in 2012 about the 2 remaining core objectives — exchanging key clinical information (eliminated as of 2013) and data privacy and security. Neither did it ask about any of the so-called menu objectives in Stage 1, such as sending patients electronic reminders about needed preventive or follow-up care.

Hospital Employment Up, Independent Practice Down

Besides charting trends in EHR adoption, the NCHS survey described how the practice of medicine evolved from 2007 to 2012 along lines that are well known to the profession:

  • The percentage of physicians in practices of 11 or more physicians nearly doubled (10.6% to 19.5%).

  • The percentage of physicians in solo practice slipped from 30.7% to 28.8%.

  • Independent practice took a nose dive, with the percentage of physicians in practices they owned decreasing from 80.6% to 63.1%. Meanwhile the percentage of physicians employed by hospitals and other healthcare corporations rose from 12.2% to 29.1% — or nearly 3 in 10 physicians.

  • The percentage of physicians working for HMOs remained essentially flat at about 3%. The same held true for community health centers, where about 3.5% of physicians work.

  • In 2012, 48.5% of physicians were in primary care, just a hair down from 49.8% in 2007.

  • Female physicians accounted for 30.3% of the profession in 2012, up from 25.3% in 2007.

The NCHS survey results are available on the CDC Web site.

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