Two recent data briefs reported strong growth in electronic health record (EHR) adoption rates among physicians, with 72% reporting EHR adoption, 66% intending to participate in the health IT incentive program, and substantial growth in nearly all the individual functionalities associated with “Meaningful Use.”

Both briefs reported new data from the same survey, the National Electronic Health Records Survey (NEHRS).  The NEHRS represents a gold standard for information on physician adoption of EHR technology.  The survey is sponsored by the Office of the National Coordinator for Health Information Technology (ONC) and is conducted by the National Center for Health Statistics (NCHS).  Survey participants are selected using scientific sampling methods, and the results are representative of all office-based physicians in the U.S. with a 67% response rate.

Read the full briefs:

• Use and Characteristics of Electronic Health Record Systems Among Office-based Physician Practices: United States, 2001-2012 (NCHS)
• Physician Adoption of Electronic Health Record Technology to Meet Meaningful Use Objectives: 2009-2012 (ONC) [PDF – 915 KB]

Interesting Data Reported on Meaningful Use Capabilities

One data point garnered particular interest, and some confusion, however.  The ONC data brief looked at the adoption rate for each Meaningful Use capability individually and found that 12 of 13 capabilities queried had adoption rates of at least 50%.  The NCHS data brief looked at a complementary composite measure: the percent of physicians who reported having all 13 Meaningful Use capabilities queried.  Among physicians who intended to participate in the Medicaid and Medicare incentive programs, only 27% reported having all 13 capabilities.

It is possible that large numbers of providers are headed for disappointment, but there are other interesting observations that may help explain at least a part of this discrepancy:

1)      EHR adoption and upgrade is in process.  At the time of data collection (February – July 2012), many physicians had recently installed their EHR and may not have implemented all capabilities fully yet.   For example, of the 66% of physicians who said they intended to participate in the incentive programs, one-third installed their EHR system in 2012 or were considering installing a new system in the next 18 months.  These physicians were less likely to report having all 13 capabilities than those who were further along in the EHR adoption and implementation process. In addition, some physicians may have been waiting for upgrades to their current EHR system.

2)      “I have that?” Some physicians may be uncertain about all the capabilities of their EHRs, especially capabilities that may be mostly used by other office staff, are new functionalities, or are not routinely used (such as reporting quality measures or providing patients with electronic copies of their health information).

3)      I don’t do that – I don’t use that.  The survey does not exactly match the Meaningful Use attestation process, so some physicians may be ready to attest even if they did not report all 13 capabilities.  For example, providers may be able to exclude certain objectives that don’t apply to their practice under the Meaningful Use attestation process (e.g., professionals who write fewer than 100 prescriptions during the reporting period can exclude the e-prescribing objective).

4)      I don’t need that yet.  About one in four providers who have received an EHR incentive payment as of October 2012 have done so under the Medicaid incentive program, for which first year payments can be received for adopting, upgrading, or implementing an EHR system. In addition, one of the capabilities queried (electronic reporting of quality measures) is a Stage 2 requirement, which is not required until 2014 at the earliest and not required for the first two years of any individual provider’s Meaningful Use journey.

Another potential point of confusion relates to how Meaningful Use requirements align with other historical measures of EHR adoption.  The NCHS data brief reported that 40% of physicians had a “basic” EHR in 2012.  A basic EHR is a system with 7 capabilities—5 are Meaningful Use Stage 1 objectives and 2 are Meaningful Use Stage 2 objectives.  So, having a basic EHR isn’t necessarily a prerequisite for achieving Meaningful Use Stage 1.  In fact, growth in the basic EHR adoption rate between 2011 and 2012 was slower than may have been expected because there was little growth in one of the capabilities — viewing imaging results–that isn’t part of Meaningful Use until Stage 2.

While monitoring all the aspects of EHR adoption, implementation, and use is a challenge (and leads to many different data points!), the NEHRS data provide important information on progress toward Meaningful Use among office-based physicians across the nation.

For More Information

EHR adoption and implementation

Meaningful Use Stages