Electronic Health Record Adoption Soars, but Physicians Opt for Simpler Systems

Although more physician practices are adopting electronic health records (EHRs), most opt for record systems with basic functions that do not have as many features to integrate with pharmacies.

According to Trends in Electronic Health Record System Use Among Office-based Physicians: United States, 2007-2012, published by the National Center for Health Statistics, EHR use has increased exponentially in recent years, but only two-fifths of physicians have adopted systems with basic features, and less than one-fourth have adopted more robust, fully functional systems.

Basic system features changed slightly during the survey, but did not significantly affect the data collected, the researchers noted. From 2007 to 2009, the basic systems needed to allow recording of patient history and demographic information, clinical notes, and patient problem lists; viewing of laboratory and imaging results; and ordering of prescriptions. From 2010 to 2012, the basic systems needed to include 1 additional feature, which was recording a list of medications in 2010, and recording a list of medications and allergies in 2011 and 2012.

Fully functional EHR systems include the features of the basic EHR systems as well as the ability to take medical histories and make follow-up notes, warn about drug interactions or contraindications, electronically send prescriptions to a pharmacy, order laboratory tests, electronically send test orders, provide reminders for guideline-based interventions, and provide out-ofrange test levels.

Despite having more features than basic EHR systems, fully functional systems still do not include all the features needed to meet meaningful use requirements specified in Medicare and Medicaid EHR incentive programs. Researchers estimate that 18% of physicians using EHRs might be eligible for meaningful use incentives, although they noted that the estimate was a maximum estimate.

Overall, EHR use increased by 37 percentage points between 2007 and 2012. The overall uptick includes a 20% increase between 2011 and 2012, and another 20% increase between 2007 and 2011.

Although the overall increase was also reflected in the adoption of fully functional EHRs, the amount of practices using the more robust systems still lags behind that of the more basic systems. By 2012, 39.6% of physicians implemented an EHR system with features that met basic system criteria, an almost 29 percentage point increase from the 11.8% using basic systems in 2007. Fully functional systems, on the other hand, had been adopted by only 23.5% of physicians in 2012, a 19 percentage point increase over the 3.8% of physicians using the systems in 2007.

After 2009, primary care physicians were more likely to implement fully functional systems than their non—primary care counterparts. The research also found that physicians in larger practices were more likely to adopt fully functional systems than solo practitioners: the gap between practices with 11 or more physicians and solo practitioners widened by approximately 20 percentage points from 2007 to 2012. A gap was also seen in practices with 6 or more physicians, and, by 2012, researchers also found a gap between solo practitioners and practices with only 3 or more physicians.

A similar albeit smaller gap exists among solo practitioners adopting basic EHR systems, suggesting that solo practitioners may face unique challenges when implementing any sort of EHR system, the researchers said.