US Electronic Health Record Adoption: What Are The Facts?

The Office of the National Coordinator for Health IT (ONC) just released several datasets, to include how our HIT Regional Extension Centers (RECs) are doing with the promotion and adoption of electronic health records. ONC funded the creation of 62 RECs in the United States with the goal of promoting HIT adoption, particularly among primary care physicians who practice in rural underserved areas. 

As of April 2012 140,057 physicians registered with a REC for possible assistance. Most of the RECs exceeded their goals in terms of signing up physicians but here are the more important statistics

  • Only 11% of primary care physicians who signed up could meet meaningful use criteria for reimbursement for use of an EHR (Peds 2%, Family Medicine 10%, General Practice 2%, Internal Medicine 13%)
  • Only 4% of physicians associated with critical access/rural hospitals could meet meaningful use
  • Only 1% of physicians associated with community health health centers could meet meaningful use
  • Only 11.5% of physicians in small practices could meet meaningful use
  • Only 5% of physicians in rural areas could meet meaningful use; compared to 9% of physicians practicing in small cities and larger cities
  • Only 7% of physicians associated with underserved areas could meet meaningful use

This dataset is the most recent resource to suggest that mainly urban and larger practices in the US are adopting EHRs and receiving reimbursement. The RECs have not been successful in reaching the goal of getting rural small primary care practices to adopt EHRs. What is the next step?....Bob Hoyt MD 

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Tags: EHR, EMR, adoption, centers, electronic, extension, health, records, regional

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Comment by John Fehintoluwa Alade on June 3, 2012 at 1:57pm

Please do you think the use of web based EMR will be efficient enough, the reliability of  network connection is essential very in the use of web based EMR. Is it not better to work on patients data manually then later synchronize or upload with a kind of remote EMR server - Just an Opinion

Comment by Bob Hoyt on May 19, 2012 at 6:20am

I assume you are speaking of smart card technology. Can you provide more information such as reference to web sites, articles, etc so we have more details? Thanks.....Bob

Comment by Dr. Gil (Gunter) Pollanz on May 19, 2012 at 5:27am

When I read the stories and the comments, most talk about the past when personel medical data, whether you call them EMR, PHR, EPR or similar are stored on professional servers. But this is the past! Today the German government has changed directions and store data on decentralized devices in teh hands of the patient. No governmental data servers for 80 Mio ciitzen! Naturally, we are proud since we are the leader in that segement and the German government uses our technology.

The real challenge came a few days when a New York Health Care Official red and studied our aproach and our technology. Security - technically solved! Privace - solved! Data strucure for use at hospitals and clinics - solved! Medcial DB - all on the patient device! Data Analysis like medication risk analysis - automated on the card! Safe use at HIS or Doctors System - solved! high volume data such as Radiolgy (DICOM) - solved. a.s.o.

What the NYC executives view is that 8 or 12 Mio citzen (patients) hold their dagta, HIMS compliant etc. etc. and have it ready, llike a credit card or driving license.

They want to start yesterday - we have proven who you can run such an approach by connecting to the German and European Medical Data Systems; I guess that it will also work in the US.

What is different: Our client is the patient, but he/she works with original, digitally signed data coming from doctors and hospitals. They can neither change nor delete data on the card and back up is in the Cloud, encrpyted (therefore for no use for Google, Facebook, MS-Health or similar).

Are you guys aware what i.e. MEDCO is doing? Data Analyis for 60 mio patients create annual revenue of 66 bio annually. 210 Mio US patients are analyzed by those companies - and we talk about how to set up data communication on a secure level - for whom? Hospials? doctors? health funds? They had their time - now it is the patient. What MEDCO does we can do on individual patient level on the mini-PC in your wallet.

Join me on that new venture - it is the future.

Gunter

Comment by Bob Hoyt on May 16, 2012 at 8:59am

Titus,

Very interesting. Given the fact that dentists are frequently more automated than their medical counterparts, I would have thought the percentage that are paperless would have been higher. My dentist/dental techs use an EDR which seems to be a good fit because of the ability to post dental drawings and dental xrays/images. I would also think that templates would be an ideal fit for dental hygienists. 

I can only guess what the true incidence of PCPs in the US that are using a fully functional EHR. Optimists have published rates as high as 40% but I suspect that is true only in suburban/urban practices. It is much lower among rural practices and those that focus on under served, under insured patients.....Bob

Comment by Titus Schleyer on May 16, 2012 at 8:42am

Hi Bob,

thanks for the info. We recently finished a study on a fairly broad sample of dentists in which about 75% used a computer to manage clinical information (not exactly equivalent to electronic dental records, but a proxy). Surprisingly, approximately 15% were completely paperless.

Here is the graph we produced based on this and other studies:

The study will be published later this year in the Journal of the American Dental Association.

How is the picture on the medical side among PCPs?

Thanks

Titus

Comment by Bob Hoyt on May 16, 2012 at 2:12am

Thank you for your recent posts Adio and Elica. Here are some additional thoughts about rural primary care doc's needs:

1. Rural docs should use web based EHRs so IT support is minimal

2. Docs should consider some of the lower cost/free EHRs out there that still meet meaningful use: Amazing Charts, Practice Fusion, SoapWare,etc.

3. Docs should customize templates for simple diseases such as URIs, low back pain, UTIs, etc so they can input info for an encounter quickly which should be as fast as a paper encounter and much cheaper than a dictated note. They should purchase a copy of non-medical voice recognition (cheap) and try it; if it works well for them adopt this strategy

4. The RECs or county medical societies should look for discount services to scan the last years worth of paper records into the new EHRs as pdfs and have a team to create a problem summary list on all active patients.

Without a well organized and supported game plan for rural primary care docs, they will so no reason to transition to electronic health records. I still go to a hardware store and marine store that use paper invoices, no bar coding, etc because it would be too expensive and disruptive for their small businesses. The same could be said for rural practices.....Bob

Comment by ADIO R. ADETONA on May 15, 2012 at 11:31pm

This is interesting Chris, the adoption of EHRs by and large is now on the increase compared to what it was used to be. More resources need to be deployed by the govt to carry physicians at the rural areas along. What is happening in US today is a motivator to countries outside US. I hope adoption of EHRs will continueto be on the increase world wide. Keep on posting to inform, thank you.

Comment by Elica S Mehr on May 15, 2012 at 10:50pm

Thanks for your information Bob. I think you have actually mentioned some of the reasons why rural area is not responding very well to these incentives. Work load and not being confident in terms of in-house technical support prevents them from thinking about new technologies. Perhaps allocating temporary technicians to their practice would be more motivational.By the way, it is great that a smooth growth is observable in the whole Meaningful use program.

Comment by Bob Hoyt on May 14, 2012 at 3:18am

Interesting comments Chris. I have never understood why rural physicians in the US are generally compensated at lower levels than in urban/suburban areas (I spent 15 years practicing Internal Medicine in a very rural area). Rural physicians are usually in 1-3 man/woman practices with little-no technical expertise and see a substantial number of patients who are under insured or uninsured. I agree that telemedicine will help with the expertise gap in rural areas. ACOs on the other hand, will probably be part of large successful integrated delivery networks (IDNs) and therefore be centered in metropolitan areas. 

It's unclear to me whether free/low cost EHRs would be any more attractive to rural physicians. They probably see the downside of disruptive new technology and no direct positive impact on their practices, so they choose not to adopt. Difficult sell.

Comment by Chris Paton on May 13, 2012 at 4:01pm

Thanks for posting this information Bob. They do look like pretty low numbers but at least we are seeing some progress in the right direction. Perhaps the benefits of meaningful use are more meaningful for larger urban centres than rural ones. Rural practices might benefit more from investment in telemedicine than EHRs, for example. Or perhaps the larger urban centres were already on their way so it was a more cost-effective exercise to meet the targets.

Overall, it seems to me (as someone outside the US) that meaningful use incentives were a reasonable way to spend stimulus money but there is a need to think about longer term incentives that are not primarily about injecting money into the economy - hopefully something the accountable care organisation initiatives can address?

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