EHR Adoption Rate Among Family Physicians Continues to Climb

Family physicians continue to outpace other office-based physicians when it comes to adopting electronic health records (EHRs), according to new research published in the January/February issue of Annals of Family Medicine.

Authors of the study, titled "The Rise of Electronic Health Record Adoption Among Family Physicians," found that the implementation rate of EHRs by FPs reached 68 percent nationwide in 2011, and has doubled since 2005. Furthermore, researchers predicted that the EHR adoption rate for family physicians as a whole likely would surpass 80 percent by the end of 2013.

EHR adoption is an important component in the federal government's overall plan to improve health care quality and lower the cost of that care in the United States, noted the researchers. In 2010, the U.S. government funded 62 regional extension centers (RECs) at a cost of $657 million to help speed physician implementation of EHR technology.

Study authors compared trends in physician uptake of EHRs by analyzing data from the American Board of Family Medicine (2005-11) and the National Ambulatory Medical Care Survey (2001-11).

They compared the rate at which family physicians adopted EHR technology with the adoption rates of other outpatient physicians. They also considered state-level geographic variations in adoption rates. Both databases showed statistically similar adoption rates for family physicians between 2005 and 2011.

With regard to variations across states, researchers reported that data obtained from the American Board of Family Medicine (ABFM) showed adoption rates were lowest in North Dakota (47.1 percent) and highest in Utah (94.9 percent).

Other states identified as having EHR adoption rates significantly higher than the ABFM national average of 62.6 percent were Georgia, Massachusetts, Minnesota, New Hampshire, Oregon, Washington and Wisconsin. The higher EHR adoption rates held true for other office-based physicians, as well.

Researchers found significantly lower adoption rates in Florida, Illinois, Michigan and Ohio based on the ABFM national average.

Family physician EHR adoption rates based on the national ambulatory survey data ranked North Carolina at the bottom (44 percent) and Hawaii at the top (87.6 percent).

The study's authors couldn't definitively say why there were significant state variances in family physicians' embrace of EHRs. They did, however, offer possible explanations.

The Annals researchers referenced a 2006 research briefing published by the University of Maryland's Center for Health information and Decision Systems and titled "State-Level HIT Activity and Themes." The report suggests that states with fewer EHR-equipped medical practices lacked statewide EHR funding initiatives designed to give physicians a financial leg up on the implementation of the often-expensive technology.

That research also suggested that a healthy number of health maintenance organizations or other integrated health systems in a state could have a positive impact on physicians' ability to implement EHRs.

"Whatever the explanation, the interstate variability could help identify areas for targeted interventions, e.g., adjustments to federal funding for various RECs," wrote the Annals researchers.

Andrew Bazemore, M.D., M.P.H., director of the Robert Graham Center for Policy Studies in Family Medicine and Primary Care, was one of the study's authors. He told AAFP News Now that the study confirmed family physicians' leadership in EHR adoption. However, he noted that the surveys from which the study data were drawn asked only the "bluntest of questions about adoption."

"Simply asking a physician if he or she has adopted an EHR allows no detail on the intensity or meaningful use of such technology," said Bazemore. For example, one practice may barely have begun to use electronic prescribing while another may be engaged in robust EHR activities, using patient portals and pairing practice management tools with the evaluation of health care quality delivered to patients.

"A simple 'yes' or 'no' question only helps us to understand the proportion of FPs who are at least minimal users of some form of EHR," said Bazemore.

Jason Mitchell, M.D., director of the AAFP's Center for Health IT, said the findings in the Annals study didn't surprise him. He pointed out that family physicians have been adopting EHR technology more rapidly than other physicians since 2005.

"Meaningful use didn't make family physicians adopt electronic health records any faster than they had in the past," said Mitchell. "They had already made a commitment to using electronic health records in their practices."

The question then becomes one of why family docs have always been ahead of the curve on this issue. For one thing, said Mitchell, the Future of Family Medicine Report, published in March 2004 as a supplement to the Annals of Family Medicine, had an impact on family physicians and gave them a vision of what the specialty could look like.

"They embraced the idea that electronic health records were essential to providing safe, high-quality and efficient care," said Mitchell.

Furthermore, family physicians have undergone intense pressure to increase their productivity and efficiency in part because of initiatives aimed at increasing primary care payment. "These changes have made family physicians particularly sensitive to finding effective practice tools to help them deliver good care on budget," said Mitchell.

He also gave credit to the AAFP for leading the charge on highlighting the benefits of EHRs. "Other medical organizations haven't made the same investment as the Academy, and they certainly didn't get on board with health IT early on," said Mitchell. "The AAFP is unique in its commitment and dedication to providing specific and dedicated health IT resources to its members."

In addition, family medicine fits hand-in-glove with a high-tech tool that's designed to collect and organize information. "I think it comes down to the issue of information management more than anything else," said Mitchell. "Family physicians see a broad spectrum of issues and problems, and we're responsible for the whole patient. That's where the efficiency of EHRs really comes into play."

Bazemore pointed to the "spirit of innovation that pervades the discipline of family medicine" and agreed that the complexity of the specialty -- combined with the AAFP's leadership -- have led to family physicians' overall embrace of EHRs.

Bazemore said the study's findings reinforce the need for increased efforts toward meaningful use of EHRs. "If, indeed, we have the vast majority of family physicians reporting EHR adoption, then we've crossed a barrier and left behind any real resistance to the idea that the EHR is a crucial component of the patient-centered medical home equation," said Bazemore.

"We need to turn our full attention to ensuring that family physicians are using their EHRs to their full capacity. And it's also time for payers to reward those physicians for using technology that is considered a hallmark of high quality and effective care in medical practice."