Survey Seeks Definitive Look at EHR Adoption

As EHRs take center stage in the healthcare movement, numerous surveys have attempted to determine their rate of use, affect on quality, and the barriers to their implementation. The results usually agree in general, but the exact numbers they produce can differ greatly. One reason is that even objective studies can be unscientific.

The Institute for Health Policy (IHP) wanted a definitive answer on how many physicians were using EHRs. They got their chance with a grant from the Office of the National Coordinator for Health Information Technology (ONC), which they used to produce the study “Electronic Health Records in Ambulatory Care—A National Survey of Physicians.” The survey, which appeared in the July 3, 2008, issue of the New England Journal of Medicine, aims to provide a scientific, accurate look at physician EHR use.

In late 2007 and early 2008, IHP used the ONC grant to survey 2,758 physicians about their degree of EHR implementation, their satisfaction with their system, perceived effect the EHR has on quality of care, and perceived barriers to EHR adoption. ONC, the federal office tasked with measuring the nation’s progress toward universal EHR implementation, called on IHP to first study EHR surveys from the past 10 years and determine if enough data already existed to establish the EHR implementation rate in physician offices. The past surveys were deemed insufficient, and IHP was commissioned to create their own definitive survey.

Before the first physician was contacted, the organizers of the IHP survey gathered several major healthcare stakeholders and spent months drawing up a specific definition of a fully functional EHR. This definition laid out the functionalities that determined whether a respondent had a full or basic EHR for purposes of the study.

This difference gave the IHP survey a much needed measuring stick that could be used to say how many US physicians are using an EHR, according to Catherine DesRoches, DrPH., an instructor in the Department of Medicine at Massachusetts General Hospital and Harvard Medical School and co-author of the survey. IHP is part of Massachusetts General Hospital.

“We were trying to move the literature beyond the surveys that relied on questions like, ‘Do you have an electronic health record system or not?’” DesRoches says.

With the strong definition of a functional EHR and a statistically valid sample of physicians, DesRoches and her team started asking questions.

Low Numbers, but Signs of Encouragement

What they found is sobering for EHR supporters. Only 4 percent of physicians have implemented a fully functional EHR; 13 percent use a basic EHR. This leaves 83 percent of US physicians who use a paper record.

“When you really look at a system that we think will have significant benefits for patient care, the number is quite low,” DesRoches says.

The survey showed that EHR use is most common in large physician groups. But even among larger groups of 50 or more doctors, half of those groups still have no EHR. In those practices with one to three physicians, only 9 percent use EHRs.

That is not good news for ONC, but the survey did uncover some encouraging findings, according to DesRoches. Sixteen percent of those with no EHR responded that their practice had purchased an EHR at the time of the survey but had not yet implemented it. Another 26 percent said their practice was planning on implementing a system in the next two years.

“We don’t want to over-interpret, particularly the 26 percent who said they intend to purchase, because these things might not come to pass,” DesRoches says. “But if they do, we are more likely to see a substantial increase in the number of physicians with electronic medical records in the next three to five years.”

Other findings included that two-thirds of surveyed physicians without EHRs said affordability is the main reason they don’t implement. Other reasons included the burden of finding the right EHR and legal liability fears. The more functional a physicians EHR, the more they felt it positively affected quality of care.

However, no survey is perfect. Those interested or supporting EHRs could have been the only ones to respond to the survey, the authors note in the published study.

Though the initial numbers are low, DesRoches says the survey is encouraging. She hopes people will look at the adoption barriers physicians explained and find incentives to encourage more widespread use, such as increasing payments to physicians who use EHRs. “I think that we have some good data that could be used to make some policy changes,” she says.

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