EHR Adoption Climbing, But Some States Falling Behind

The National Ambulatory Medical Care Survey (NAMCS) conducted by the National Center for Health Statistics (NCHS) is an annual nationally representative survey of patient visits to office-based physicians that collects information on use of electronic health record (EHR). The latest NCHS Data Brief from CDC shows improvement in overall adoption of EHR's this past year, but some states are starting to fall behind and there are some disturbing signs that many physicians are either unsure or opting not to participate in the EHR Incentive Program. Some key findings in the latest survey include:

• In 2013, 78% of office-based physicians used any type of EHR system, up from 18% in 2001.
• In 2013, 48% of office-based physicians reported having a system that met the criteria for a basic system, up from 11% in 2006. The percentage of physicians with basic systems by state ranged from 21% in New Jersey to 83% in North Dakota.
• In 2013, 69% of office-based physicians reported that they intended to participate (i.e., they planned to apply or already had applied) in meaningful use incentives. About 13% of all office-based physicians reported that they both intended to participate in meaningful use incentives and had EHR systems with the capabilities to support 14 of the Stage 2 Core Set objectives for meaningful use.
• From 2010 (the earliest year that trend data are available) to 2013, physician adoption of EHRs able to support various Stage 2 meaningful use objectives increased significantly; however, many physicians who plan to participate in the program do not yet have systems ready.

Besides reporting on all or partial EHR systems, physicians reported the computerized functionalities in their practices. Systems defined as basic include the following functionalities: patient demographic information, patient problem lists, clinical notes, orders for prescriptions, and viewing laboratory and imaging results. The adoption of basic EHR systems by office-based physicians increased 21% between 2012 and 2013, and the use of any type of EHR system by office-based physicians increased from 18% in 2001 to 48% in 2009 and 78% in the 2013 estimates; 2009 is the year the HITECH Act authorized incentive payments to increase EHR adoption. In 2013, 48% of office-based physicians reported having a system that met the criteria for a basic system, up from 11% in 2006—the first year that information on basic systems is available.

However, the adoption of EHR systems varied widely across states. In 2013, the percentage of physicians who had a system meeting the criteria for a basic system ranged from 21% in New Jersey to 83% in North Dakota. The percentage of physicians who had a system meeting the criteria for a basic system was lower than the national average (48%) in eight states (Connecticut, Maryland, Nevada, New Jersey, Oklahoma, Vermont, West Virginia, and Wyoming) and higher than the national average in nine states (Iowa, Massachusetts, Minnesota, North Dakota, Oregon, South Dakota, Utah, Washington, and Wisconsin). In 2013, the percentage of physicians using any type of EHR system ranged from 66% in New Jersey to 94% in Minnesota.

And the latest figures show over 31% of physicians are uncertain or do not intend to participate in the Medicare or Medicaid EHR Incentive Programs as of 2013. I expect we may see some higher non-participation in 2014, and certainly an increase in the seeking of hardship exemptions. Only about 13% of all office-based physicians reported that they both intended to participate in meaningful use incentives and had EHR systems with the capabilities to support 14 of the 17 Stage 2 Core Set objectives for meaningful use. Fully 56% of physicians plan to participate but are not ready.

There is little doubt we are making great progress in the adoption of EHR's, especially compared to five years ago primarily as a result of the EHR Incentive Program. While strides are being made there are challenges throughout the country, particularly in rural and underserved areas. And since many vendors are falling behind in meeting the certification criteria we are starting to see physician readiness to participate in meaningful use start to stall. As Karen DeSalvo said during our talk at HIMSS below, it is now time to pause and take a breath and take stock of where we are and chart the best path forward in driving towards the actual meaningful use of health information technology.