Low Physician EHR Adoption Rates a Concern

A recently released study examining physicians' use of electronic health records, or EHRs, in the United States concluded that just 4 percent of physicians have an extensive, fully functional EHR at their fingertips. Another 13 percent of physicians reported that they were using a basic EHR.

The study, "Electronic Health Records in Ambulatory Care -- A National Survey of Physicians," was published June 18 as an online special article by the New England Journal of Medicine and is available to readers at no charge. The study will appear in the July 3 NEJM print issue.

The researchers said that other recent estimates of EHR adoption rates -- ranging from 9 percent to 29 percent -- may have been too high because those rates were "derived from studies that either had a small number of respondents or incompletely specified definitions of an electronic health record."

"Our study indicates that electronic health records are available in the office setting to only a small minority (17 percent) of U.S. physicians at present," said the authors. Of the 83 percent of respondents who said they did not have an EHR, 16 percent reported that they had purchased but not yet implemented a system. Another 26 percent said that they had plans to purchase an EHR within two years.

The U.S. health care system "faces major challenges in taking full advantage of electronic health records to realize its health care goals," said the authors, acknowledging President Bush's goal of promoting widespread EHR adoption by 2014, as well as the billions of dollars it will take to achieve that goal.

"Whether any future federal administration will find the necessary resources is uncertain," they added.

The survey, supported by HHS' Office of the National Coordinator for Health Information Technology, was designed to pinpoint what percentage of the nation's physicians were using EHRs, physicians' satisfaction levels with the systems they were using, and what effect, if any, the EHR had on the quality of health care delivered to patients.

The 62 percent response rate included input from 2,758 physicians.

Investigators deemed EHR systems "fully functional" if they recorded patients' clinical and demographic data, viewed and managed laboratory and imaging tests, managed order entry and supported clinical decisions.

Overall, the authors concluded that physicians using fully functional and basic EHRs were generally satisfied with their systems and thought their EHRs improved the quality of health care they provided.

Specifically, survey results showed that among the 4 percent of physicians with fully functioning EHR systems:

Furthermore, nearly 85 percent of physicians with high-functioning EHRs reported a positive effect on the delivery of long-term and preventive care.

Study authors noted that physicians with basic systems generally reported lower overall effects on health care delivery.

The study also addressed barriers to EHR adoption. About 66 percent of physicians who lacked access to an EHR cited cost as the main obstacle. Other barriers to EHR adoption cited by physicians included an inability to match a system to the physicians' needs (54 percent) and concern about the return on investment (50 percent). Another 44 percent of respondents cited concerns that a purchased system would become obsolete.

Family physicians continue to stay ahead of the EHR adoption curve. In July 2007, the AAFP reported survey findings for Academy members using EHRs. At that time, 37 percent of the 459 survey respondents said they had fully implemented an EHR and another 13 percent said that the implementation process was under way.

"The Academy has pushed for EHR adoption since 1999 and has invested a lot of time and energy to provide resources to encourage family physicians," said Steven Waldren, M.D., director of the Academy's Center for Health Information Technology, or CHiT. He called AAFP's rate of EHR implementation "a testament to the leadership of family physicians in the health IT arena."

Waldren said a 2008 EHR member survey has recently been completed and those results, set for release later this summer, will show that more FPs are using at least basic EHR systems than was reported in the national study reported in NEJM.

The nearly 25 percent response rate to that survey -- as well as AAFP's concise definition of an EHR -- should erases any doubts about the accuracy of the AAFP's survey results, said Waldren.