New EHR Adoption Statistics
The CDC recently released its latest report on the adoption of electronic health records/electronic medical records (EHR/EMR) amongst office-based physicians from the National Ambulatory Medical Care Survey. As a physician who trained and initially practiced in a time where nearly every order, record, and prescription was paper-based, the results are striking to me.
The final results for 2008 show about 16.7 percent of physicians reported having systems that met the criteria of a basic EHR/EMR system, and about 4.4 percent reported that of a fully functional system. Preliminary results for 2009 show about 20.5 percent reported having systems that met the criteria of a basic system, and 6.3 percent reported that of a fully functional system.
Combined basic and fully functional statistics for the last 3 years are as follows:
- 2007 – 17%,
- 2008 – 21%,
- Preliminary 2009 – 27%
The latest figures, especially the preliminary 2009 numbers, suggest that the pace of adoption of HIT is quickening. We expect that the federal government’s health IT strategy will accelerate the pace even further by systematically addressing the obstacles physicians experience in adopting health IT (see below).
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HOW THE US FEDERAL GOVERNMENT IS SUPPORTING HEALTH INFORMATION TECHNOLOGY USE The Obama administration believes health information technology (HIT) is a critical component of efforts to improve the quality, efficiency, and value of care delivered to patients. The Office of the National Coordinator for Health Information Technology (ONC) is leading the administration’s efforts to support the thoughtful application of HIT. Cognizant of the numerous barriers that exist to making health IT work in real-world settings, the ONC is administering programs to systematically address these barriers:
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The vision of a health care system that uses information technology to improve the value of services to patients is inching closer towards reality.
The ONC is committed to making the transition to electronic health records successful for every physician and hospital.
I hope you will share the experiences, challenges, and success stories that belie these encouraging statistics.
– David Blumenthal, M.D., M.P.P. – National Coordinator for Health Information Technology
* 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 EMR/EHR.NAMCS provides the only source of methodologically sound, comparable, longitudinal data to track EHR adoption by American physicians, and as such, is an invaluable tool.
The value of electronic health records is enormous, but doctors should not have to deal with the additional complexities of managing, securing and supporting the the electronic health records of their patients. Instead, health records and the infrastructure to support them should be managed by software service providers and doctors should be encouraged to sign up to these service providers who can bring down the costs of managing such data. At the same time, such providers can focus efforts on security of the health records of patients to avoid loss of data to those who would misuse it.
New NAMCS survey to measure progress toward goals for EHR adoption.
“The NAMCS target universe consists of all office visits made by ambulatory patients to non-Federal office-based physicians (excluding those in the specialties of anesthesiology, radiology, and pathology) who are engaged in direct patient care.” (http://edocket.access.gpo.gov/2010/2010-1937.htm)
It seems this target universe would also be a good way to define eligible providers to receive incentive payments for meaningful use of an EHR.
The administration essentially started health care reform when it enacted ARRA/HITECH, creating a foundation to use health IT for collection, analysis, and sharing of actionable data in support of improved clinical decisions and outcomes, operational efficiencies, and true coordination of care for the patient. Our leadership is now being challenged to effectuate policy objectives in a very real way. Health IT and moving to aggregated, coordinated care is one of the few bipartisan goals from where I sit, and can actually reform health care regardless of legislation on the subject. I appreciate the work being done.
Actually, you are mistaken. All this ARRA fuss is making folks consider EHR for the wrong reasons, and therefore I predict it will be a near-failure. Besides, the only concrete action taken by this administration and CMS has been detrimental to effective coordination of care and sharing of clinical information. If you are not aware, CMS has decided not to recognize consultation codes as an independent code. Thereby, not only will Medicare beneficiaries loose the valuable care provided by Specialist physicians, but also will loose the valuable exchange of clinical information that will no longer be provided. As long as govt continues to actively interfere with the practice of medicine, there cannot be true reform. Hope the author of this blog takes heed.
Hopefully the federal government’s health IT strategy will accelerate the further step to systematically overcome the doctor’s experience adopting health IT.
I particularly appreciated hearing differing opinions and experiences in the comments on this post. Provider adoption and meaningful use of EHRs is the end goal of which I never lose sight, and therefore a critical topic for continuous conversation. As we move forward in this process, your experiences and perceptions of the benefits and challenges to meaningful use of EHRs are crucial to the successful development of a nation-wide electronic health information system. Thank you for taking the time to comment and please continue to participate.
Thank you Dr. Blumenthal for taking the time to comment. One of the biggest obstacles I’ve seen is regarding critical access hospitals and small rural providers. I hope we see a strategy develop for tackling this significant barrier. Is there maybe more going on behind the scenes that we aren’t aware of? It seems as things currently stand the larger systems with the most resources are poised to qualify for incentive payments, while rural areas struggle to catch up…
I agree. You can include all small//solo practices in other regions as well. Mine is a solo practice that has been fully electronic for almost 8 years (even before the Cleveland Clinic, that always seems to be in the news). Yet, the only benefit/incentive I have received is a 2.5% discount from my Liability Insurance Carrier, Medical Protective, since 2007.
Neither governmental nor private payers have shown any interest in even learning from us the various ingenious patient-care methods we have developed, those that our patients recognize as great value. It would really be worthwhile if there was some financial recognition of our efforts. Good to see Dr. Blumenthal participate in this blog.
It would also be nice to see HHS work to increase connectivity between hospitals and physician offices. Currently, hospitals basically hold physicians hostage and allow connectivity only if they buy EHR products that the hospital has. For those of us that affiliate with multiple hospitals, it is an unworkable situation.
I am aware of the CMS consultation code change, and very much understand your high level of frustration – yet, fee scheduling is unrelated to the need for nation-wide EHR adoption. The goals of the current administration and the previous administration related to adoption of EHR technology are no different. Pres. Bush created the ONC in 2004 through an executive order, charging the office with establishing federal activities necessary to implement a strategic plan for EHR adoption by 2014. 2014 is not a new timeline, nor is moving from pay-for-service to pay-for-value a new concept. As shown in the NAMCS survey trend, I believe EHR adoption is imminent.
If you look back to healthcare IT in the mid-80’s, the technology for eClaims and eRemits existed, but paper claims prevailed. Then in 1996, the Kennedy Kassebaum Act was signed, legislating HIPAA and standardizing electronic administrative and financial data. This shift impacting the technical and operational aspects of every facet of healthcare. Today, it is the de-facto standard – providers would not even consider a practice management system that could not manage electronic claims. Enter EHR technology. It’s been around since late 1999/2000, but in all that time U.S. physician adoption has been slow to non-existent. Like the Kennedy Kassebaum Act, ARRA legislates EHR. Use of EHR as a change agent will impact every aspect healthcare delivery – from urban centers to shortage and underserved areas. The change will not come without barriers, be they technological or user-based. But, the ensuing benefits are real. The regional extension centers will hopefully provide the critical support needed at the local level for physicians to succeed.
Adele, you are missing the forest for the trees, here. The basic objective of an electronic medical universe is to be able to share information/opinions/consultations/recommendations, etc. electronically. When CMS kills the one process that encourages sharing of information, the whole argument falls on its face. What this Dept of HHS is telling the practicing physician is that this is just lip service. Removal of consultation codes is at the heart of this problem.
By the way, pay-for-service and pay-for-value need not be mutually exclusive; it could be pay-for- valuable service, as it should be. Unfortunately, simply using EHRs does not mean high value service, and vice versa. And, as any clinician can attest, claims submission is a very different process from providing and documenting medical care. Trust me, coming from an 8-year EMR user, that the technology has a long way to go to even come close to providing appropriate solutions to medical practice, because practice of medicine is an art form, not simple science, and computers and technology have a long way to go in matching the needs of the clinician with appropriate solutions. Vendors are simply interested in selling bits and pieces and nickle & diming their customers. Our reimbursements needs to go much higher (not lower as CMS plans to do) if we have to afford the expensive technology of today. And the worst thing the government could have done was to legislate EHR. Society will loose great clinicians because of this; and we will be left with are doctors that are great with computers and documenting, but without much clinical skills; until a whole new generation of doctors are trained/groomed into balancing these two qualities (my optimistic assumption).
When you consider that we are in the 21st Centuary, a life style which is based around digital services and media, you would have thought that something would have now been kicked into shape… as it is, the problems are from the paper waste, because it is costing the Government more and more each year, to recycle something which is clearly not bringing in any revenue, and costs about $60+K each year to manage.
Dread to think how much of an easy life they have, when you consider how much free junk we get through the mail box every day!
As an IT professional I am extremely excited to see support for this movement. I have been involved with Pilot Programs in the Health IT arena and have also successfully moved lawyers and accounting firms to paperless environments. There is no reason the medical world cannot do the same!
You have my support
I’m also an IT professional who is glad to see this gaining support. It’s about time for the health IT field to move from maintaining archaic systems that kept everything in proprietary formats to focusing on methods of open standards and communication that can really translate into improved levels of care, value and efficiency.
Electronic records are certainly a step in the right direction. If this data can mined anonymously in order to establish comparative effectiveness with certain chronic conditions then all the better. It would also be nice if IT was a small part of lowering overall health costs when combined with other initiatives.
Why is no one talking about how lousy available options are for capturing the essence of the clinical encounter–the narrative? I have spoken to countless Health IT folks who still can’t grasp my workflow and needs. Just follow me around an ER for a day. In all these Health IT chat rooms a bunch of computer people scratch their heads wondering why we’re not adopting EMR faster. Well, why isn’t EMR adapting to our workflow? Until I see an app with a simple clean interface, patient tracking, easy-to-access MPH, that I can carry around with me, write on, dictate into, capture the essence of my patient encounter as a single legal document–oh wait, that would be a paper chart and a dictaphone. Seriously.
How true. I have been talking to walls for years about the same things. However, we have a very neat EMR product that we have successfully used to create our own work flow in our office for almost 6 years. But most IT vendors really don’t care to do it. They would rather have you change your methods to adapt to their product.
It amazes me the resistance physicians have to EMR. Not every EMR is a great product. Most are template driven and extremely rigid in their workflow and expensive to customize. But there are those that will adapt and learn from the user and very are easy to customize. My suggestion would be to look for those solutions that are non-template. Seriously, there are tremendous benefits to a digital record over paper charts for the patients, payors and yes even the doctors. Until the doctors get on board these benefits won’t be realized by anyone.
Great comment. Would love to learn more about how you see the next gen EMR addressing your concerns.
Customizing your EMR to a manual work flow is like designing a car so you can get a horse saddle onto it.
If you want a poor EMR implementation, spend thousands of dollars changing carefully designed software to fit a manual workflow. EMR vendors, however, have spent time with more than one doctor, and when people say “EMR Vendors do not understand doctors” what they are really saying is “EMR vendors talked to a doctor who works differently than I do and I know a lot more than the doctor they used”.
If you look, you will possibly learn that they have decent workflows and by adopting THEIR workflow will make your life easier in the long run.
EPIC (a company I have no connection to at all) forces providers to work THEIR way. THAT is why they are so incredibly successful – and providers using EPIC end up with better data and better management of patients than where 150 workflows are adopted with templates
(My new doc uses Epic, and he is much better at treating me than the doctor who worked at a clinic where they kept using paper and pencil and then transcribed data to the computer – better because I do not have to tell the nurse my “medical history” EVERY time I call with a problem. I am sure the old clinic is certain that their manual process was providing better treatment (their website says they have the best – of course) – as long as my answers on medical history were absolutely accurate every time I called. Yeah – right. The Last of the Luddites).
(1) Is there a reason that Physician Assistants (PA’s) are not included in the ARRA as eligible providers? In our clinics we have 15 PA’s and 15 FP physicians — but we cannot access stimulus funds on behalf of the PA’s. If this is an accident, it should be corrected If it is a deliberate omission — we do not understand the rationale, since Nurse-Practitioners are specifically included.
(2) Is there a reason that Rural Health Clinics (RHC’s) are, for all practical purposes, excluded from receiving ARRA HIT stimulus funding? The closely related FQHC’s / Community Health Centers receive specifically designated benefits. RHC’s are located in rural areas which generally have high proportions of elderly patients, covered by Medicare. However, RHC’s are required to bill Medicare Part A, not Part B, for services. Therefore RHC’s cannot access any significant funds under the Medicare provisions of the ARRA. Furthermore, since the rural areas have such a preponderance of elderly, the proportion of patients on Medicaid, or uninsured, will be lower than in an area with a more average population age. RHC’s are required to employ a PA at least 50% of its hours of operation, furthermore eliminating access to funds.
(3) Since these problems lie within the ARRA provisions, it isn’t clear if they can be corrected without legislation. They essentially disenfranchise a large part of the “safety net” clinics — and inappropriately discriminate against one class of providers, who are much needed in meeting primary care access goals.
Seems like this is behind the curve when compared to the forward thinking of other industries.
I agree Surgery Houston. With all the advancements that have been made in digital technology and space travel you would think there is nothing “they” couldn’t figure out. But I guess it all comes down to money… maybe too much money being spent where it doesn’t need to be?
As I read through all of these comments I feel as though I am hearing some very good discussion surrounding what may be “missing” from ARRA as well as challanges that providers face in adopting EHR’s.
I would, however, like to add a few things for consideration from a different perspective. As someone who works as an HIT project manager, I have worked with varying sized ambulatory clinics in implementing EHR’s. Outside of hurdles with the software itself, which will be had regardless of the software purchased (one must remember that it is software), there are several critical factors that are often missed by providers/administrators. This is not just my perspective, I attended a seminar last week in which someone shared the stat that EHR implementations fail 70% of the time on the initial try. I believe there is also numerous data and horror stories available on the web to support the fact that EHR adoption is a difficult task.
What has me most excited about ARRA is the whole idea of improving patient care, along with interoperability. Implementing EHR’s is not just for the sole purpose of sharing data (as someone here suggested), there are enormous benefits to having systems that can alert providers to contraindications, manage care for high risk patients, manage health maintenance, or streamline workflows, etc… Things which are extremely difficult to manage in an accurate and effective manner in the paper world.
What has me least excited about ARRA is the “rush” to implement so as to collect funding. I would not be surprised to see the 70% failure rate increase dramatically as an unintended side-affect of ARRA. The reality is that for practices who have not yet purchased an EHR today, or not yet begun their implementation, it is HIGHLY unlikely that they will be “meaningful” users by 2011 or even 2012 at that. This will be due to a poorly planned and poorly executed implementation, or simply put a rushed implementation.
Some of the most fatal errors in EHR implementations, which I have personally experienced:
Lack of communication
1) Underestimating time committments
2) Expecting the software to conform to unique workflow/practice needs without hurdles or human intervention
3) Reducing vendor training as a means of “saving” (this almost always ends up costing practices much more)
4) Purchasing an EHR without buy-in from physicians, or heavy involvement in the implementation
5) Tyring to implement too much, in too short a time frame
6) Not having an internal Project Manger (who can devote 25 – 75% of their FTE to the project – dependant on practice size)
7) Forgetting that the software is software – some processes that were completed in the paper world will simply need to continue to be done manually – EHR’s do not offer mind-reading functionality and will not prepare the coffee in the morning
9) Scope creep
10) Inadequate resources – both monetary and human
Personally I would like to see a at least one change to the current proposed rules for meaningful use. Due to the existing low adoption rate of EHR’s, I believe the phase one expectations are too high. Perhaps allowing EP’s to meet a certain percentage of the 25 criteria the first year would be better – something around 60%? This may help providers keep focused on actually implementing in a meaningful way rather than cramming everything in just to try to meet the criteria. As far as the certification of EHR’s – all I can say is IT’S ABOUT TIME!
When you consider that we are in the 21st Centuary, a life style which is based around digital services and media, you would have thought that something would have now been kicked into shape… as it is, the problems are from the paper waste, because it is costing the Government more and more each year, to recycle something which is clearly not bringing in any revenue, and costs about $60+K each year to manage.
Dread to think how much of an easy life they have, when you consider how much free junk we get through the mail box every day!
very well said totally agree with you 100%
What affect will full integration of this have on the costs of stafing current work force that this technology will replace? Administrative costs for keeping track of this information will greatly reduce once their positions are antiquated. Hopefully that will help lower health care costs overall in the future.
It seems as though America is rarely ever able to benefit from other countries in these matters. We blaze the trails and others follow eliminating costs and effort. It would be nice to have joint partner in order to move projects along faster and at lesser costs.
The slow adoption rate of EMR/EHR is really frustrating. Do physicians not realise that this simply benefits them?
I believe that physicians recognize the benefits, however the don’t like the cost to them.
I have physicians and other medical, dental, health care providers contact me about scanning
their x-rays before and after they go to digital imaging. Cost is always a issue.
Combined basic and fully functional statistics for the last 3 years are as follows:
* 2007 – 17%,
* 2008 – 21%,
* Preliminary 2009 – 27%
This is a good start, hopefully the percentage will multiply 3x or more over the next
couple of years. Bring IT into the health care system faster for improved patient care
and cost savings.
The adoption of EMR is like a slingshot… You have to pull back in order to shoot forward. Physicians and providers are concentrating on the pull back of their operations and denying the progress and efficiency that it will create, even if they are agreeable that it will create efficiency. In order for this to become a nationally accepted use of technology in healthcare, certain levels of success must be experienced and widely acknowledged. I sell more than just one “A-Class” EMR and PM solution and I’m very well versed in the concepts and contraversy surrounding this topic. Please reply if you have questions or comments. Thank you.
Why can’t physicians easily adopt methods based on saas providers in other industries? I know that my law office uses several saas providers for our client data. This includes two different cms systems and document assembly.
We are at the point where usability and intuitiveness for informational systems should not be a problem. Unfortunately most programmers are not very good with designing ergonomic and easily used information interfaces. Of course doctors have enough to worry about and manage but as for their assistants, who process patient records, they should have collaborative input with electronic informational system design.
Doctors don’t have the luxury of time to manage electronic health resords, yes Wellescent Health is right, software service providers can help a lot in improving this system. I feveryone will cooperate and help each other, I think this system will be great.
It seems that the benefits are clear to most, however the barrier still relates to cost, especially in more rural areas (even for hospitals in these areas). This is one area where costs are still hyper-inflated compared to similar technology in other fields. It seems that something should be done to help regulate costs better as competition hasn’t had much effect on it yet.
Here in the UK, as part of our National Health Service, electronic record adoption has been rolled out to everyone to cut admin time massively. I feel the government should be a one-stop place for all their records they have on each person… I get sick of writing my address out on 20 different government forms each year – this is inefficiency on a national scale!