There may be general agreement about how many physicians have adopted electronic health records (EHRs), but the degree to which doctors are satisfied with their EHR systems and the factors driving adoption appear to be less clear.
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Two surveys released recently, one by the National Center for Health Statistics (NCHS) and the other by the publication Physician Practice, both indicated physician adoption of EHR systems sits just above 50%. The former showed that 55% of doctors have some form of EHR in place, while the latter indicated a 54% adoption rate. However, when it comes to satisfaction with available options and the reasons for implementing the technology, doctors are anything but in agreement.
The NCHS survey indicated 47% of current EHR users are somewhat satisfied with their systems, while an additional 38% reported being very satisfied. About three-quarters said their EHR system enhanced patient care. The numbers suggest current users have relatively high opinions of the technology, but the Physician Practice survey reveals distrust among non-users.
That survey revealed 29% of respondents view EHRs as being too expensive; 14% of physicians aren't interested in using EHRs; 13% cannot find a system that meets their needs, and 8% have heard horror stories about implementations gone wrong.
One reason for the divergent views on EHR benefits may be related to the specialty of the doctors involved in each survey. IDC Health Insights analyst Judy Hanover said pediatricians and primary care doctors can typically find vendors offering systems that are tailored to their needs, but specialists may find few options that are relevant to their practice. These professionals may have to manually configure templates and find other ways to enhance usability, which can lead to frustration, she said.
Steven Waldren, the director of the Center for Health IT at the American Academy of Family Physicians (AAFP), said he was surprised to see such high satisfaction numbers in the NCHS survey. He said he commonly hears physicians complain about their EHR systems, and while this does not necessarily mean they are dissatisfied with the technology, he did not expect to see 38% of users claim to be very satisfied.
Satisfaction is always a benchmark against what you think technology should do.
director of the Center for Health IT, American Academy of Family Physicians
One factor that may have driven such high satisfaction rates may be the fact that many current users have adopted newer systems in recent years. Waldren pointed out that 41% of EHR users have Web-based systems, according to the NCHS survey. Because this technology, which offers a less hardware-intensive implementation, has only been widely available for a couple years, the survey result suggests many physicians have new EHR systems that may have enhanced usability.
The two surveys also highlight differing views on why physicians are adopting EHRs, particularly in regards to the government's meaningful use program. The NCHS survey indicated that about three-quarters of physicians who have adopted EHRs meet the requirements of the meaningful use program. Hanover said this is an indication the program is guiding EHR implementation.
"Physicians recognize that this is a one-time opportunity," Hanover said. "They've recognized for a long time that this technology was necessary, but the financial obstacles are very costly." She added that the meaningful use program helps remove much of the financial burden of EHR implementation, which is a significant part of the reason rates of EHR use have climbed so rapidly in recent years.
But implementation costs are still a barrier to entry for some. In the Physician Practice survey, 52 % of respondents said they were no more likely to adopt an EHR system now that the government has started administering incentive payments. While many new adopters may have been swayed by the availability of financial incentives, there is a large percentage of providers for whom payment bonuses are simply not that important, Waldren said.
He pointed out that doctors who implemented EHR systems prior to the advent of the meaningful use program and those who do not plan to adopt the technology at any point will not be influenced by the availability of incentive payments. When these two groups are added up, they comprise a relatively large number of physicians.
Both experts agree that while the two surveys point to a leveling off of EHR adoption, rates should start increasing again by the fall. Hanover said that the rule pushing back the deadline for attesting to meaningful use, which was proposed as part of the Stage 2 regulations, removed some of the urgency. But if historic adoption rates hold, the number of physicians using the technology should continue to increase. She expects to see between 70% to 80% of physicians using EHRs by 2016, as adoption rates have been trending upward since the launch of the meaningful use program.
"We've gone from less than 20% in 2009 to more than 50% in 2012 -- that's phenomenal levels of adoption," Hanover said.
Waldren agreed that EHR implementations should pick up in the fall, when physicians' last opportunity to complete their 90-day reporting period for attesting to meaningful use in 2012 approaches. He also sees changes coming to the health care system -- including the growing use of accountable care organizations -- as influencing physicians' perception of the necessity of an EHR and expectations of functionality.
"Satisfaction is always a benchmark against what you think technology should do," Waldren said. "As we migrate away from fee-for-service to payment based on quality, what we expect of these systems will be different and satisfaction will change."