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About 40% of physicians in the United States have adopted a basic electronic health record system, but few are able to use those systems to exchange clinical information with other offices or generate quality metrics, according to a survey of more than 1,800 physicians.
The Harris Interactive survey found that 45% of primary care physicians and 41% of specialists met the criteria for having a "basic" EHR system, defined as a system that allows physicians to maintain problem and medication lists, view laboratory and radiology results, record clinical notes, and order prescriptions electronically.
A much smaller portion of physicians – 10% of those surveyed – met the study’s criteria for achieving "meaningful use" of their electronic systems. More primary care physicians (11%) were able to perform all 11 meaningful use elements identified by researchers, compared to 8% of specialists who were surveyed. The findings were published in the June 4 issue of the Annals of Internal Medicine (2013;158:791-9 [doi:10.7326/0003-4819-158-11-201306040-00003]).
The meaningful use definition created by the researchers is similar, but slightly less stringent, than is the stage 1 meaningful use criteria used by Medicare for its EHR incentive program. Physicians were most likely to be able to meet the requirements for viewing laboratory results, e-prescribing, viewing radiology images, and recording clinical notes. But they had more difficulty exchanging clinical summaries and laboratory results with other offices, generating quality metrics, and providing patients with after-visit summaries or copies of their health information, the researcher found.
"Computerized systems for patient panel management and quality reporting do not seem widespread, and where they are implemented, physicians reported that they are not always easy to use," the researchers wrote.
The study’s meaningful use numbers are much lower than those cited in a recent report from the Health and Human Services department, which put meaningful use by eligible providers, who are mainly physicians, at more than 50% as of April 2013. Part of the difference has to do with the timing of the survey, according to Dr. Jason M. Mitchell, director of the American Academy of Family Physician’s Center for Health IT. The survey published in the Annals was conducted between October 2011 and March 2012. During a similar timeframe (May 2011 to September 2012), the number of eligible professionals qualifying for meaningful use payments was a little more than 82,000. But uptake of EHRs and compliance with meaningful use soared in 2012, bringing the number of eligible professionals up to more than 291,000 by April 2013, according to HHS.
Other surveys of physician adoption may have substantially larger numbers because they only ask physicians if they are using an EHR. Dr. Mitchell said surveys of AAFP members estimate EHR adoption at about 73% as of the end of 2012 using that type of general question.
The study also noted that physicians are having difficult time in successfully using some EHR functionality, especially functions related to population management. For instance, 25% of physicians said they had difficulty or could not generate a list of patients by laboratory result even though they had a system that was supposed to perform that task.
Only in the last year or so have more vendors started to understand the importance of population-management functions, such as registry capability, said Dr. Mitchell. "It is difficult to get to those more advanced kinds of functions."
Another issue is that many EHRs don’t store information in discreet fields that can be searched later to aid in prevention or disease management, Dr. Mitchell said. Instead, physicians often dictate information into large text blocks that aren’t searchable by the system. Moving to systems that would allow doctors to search for all patients with a specific lab value, for example, will require both technological changes and more time-intensive data entry by physicians.
"We’re still trying to sell that concept to the providers who are running on the treadmill as quick as they can to be able to get patients seen," he said. "They are beginning to see the value of being able to do that data aggregation and looking at populations, but it’s different from what we’ve been doing."
The study also looked at how physicians viewed the increased use of EHRs in terms of their potential to improve the quality, cost, and efficiency of care. When it comes to quality, 57% of physicians said EHRs would have a positive impact vs. 28% who said they would have no effect and 13% who said they would have a negative impact. Physicians had similar opinions about the efficiency of care with 56% responding that EHRs would have a positive effect.