Health Affairs: EHR adoption programs should look beyond PCPs

To achieve EHR adoption nationwide, federal policies also may have to focus on encouraging adoption among non-primary care specialists, as well as addressing persistent gaps in the use of EHR systems by practice size, physician age and ownership status, according to an article published in the April edition of Health Affairs.

By 2011 more than half of all office-based physicians were using electronic health record systems, but only about one-third of those physicians had systems with basic features such as the abilities to record information on patient demographics, view laboratory and imaging results, maintain problem lists, compile clinical notes, or manage computerized prescription ordering, wrote Sandra L. Decker, economist at the Centers for Disease Control and Prevention’s National Center for Health Statistics in Hyattsville, Md., and colleagues.

Using data from the annual National Ambulatory Medical Care Survey from 2002 through 2011, the researchers examined adoption of EHR systems and physician characteristics associated with adoption. Beginning with 2007, they also analyzed adoption of EHR systems that had certain basic functions, including the ability to record information on patient demographics; compile problem lists; document medications; store clinical notes; view laboratory and imaging results; and execute computerized prescription ordering. 

Physicians who reported using any EHR system increased 38 percentage points. “Primary care specialists were slightly more likely than those in nonprimary care specialties to use EHR systems in 2002,” the authors wrote. “Over the decade, adoption of any EHR system among primary care specialists increased more quickly, so that by 2011 the difference in adoption between primary care specialists and others had widened. Primary care specialists’ adoption of EHR systems with basic functions also exceeded that of nonprimary care specialists from the first measurement of these functions in 2007.”

Although primary care specialists’ adoption of basic systems continued to rise into 2011, reaching 41 percent, the percentage of nonprimary care specialists with basic systems stalled from 2009 to 2010, then rose to 32 percent by 2011, the authors found.

“Differences in adoption by specialty, physician age, practice size and ownership remained roughly the same size or became larger during the decade,” Decker and colleagues noted. “These patterns are related, because—compared to younger providers—physicians older than age 55 are more likely to be in smaller practices and in practices owned by physicians or physician groups rather than by other organizations.” 

Despite increases over the past decade, no category of physicians has achieved a high level of adoption of basic EHR systems, the report concluded, adding that programs may need to include focus on physicians outside of primary care to narrow the gap in EHR adoption.