ONC Researchers Hunt for Clues

What Factors Influence Physician EHR Adoption?

December 10, 2014 04:31 pm Sheri Porter

New research released by the Office of the National Coordinator for Health Information Technology (ONC), gives readers a glimpse into U.S. physicians' embrace of electronic health record (EHR) technology, as well as issues that have chilled physicians' interest in implementing EHRs.

David Voran, M.D., a family physician practicing in Kansas City, Mo., and an early electronic health records adopter, relies on his EHR to help him keep his patients healthy.

According to a December ONC data brief(www.healthit.gov), some 80 percent of physicians who participated in the Physician Workflow Survey portion of the 2013 National Ambulatory Medical Care Survey(www.cdc.gov) said they were already using an EHR or planned to implement the technology.

However, about 10 percent of responding physicians had no plans to adopt an EHR, and of those nonadopters, 41 percent said their decision was based on a plan to retire.

According to an HHS press release(www.hhs.gov) about the ONC brief, the federal government was interested in learning about what drove physicians to implement or not implement EHRs and the level of importance that financial incentives played.

For instance, the 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act provided funding for the Medicare and Medicaid EHR Incentive Programs and meant bonuses for physicians who met meaningful use objectives and penalties for those who did not.

Story Highlights
  • The Office of the National Coordinator for Health Information Technology released a research brief aimed at identifying reasons that physicians do, or do not, embrace electronic health records (EHRs).
  • Some 80 percent of physician survey respondents said they had already implemented or planned to implement an EHR.
  • Primary care physicians led other medical specialties in adoption rates and a majority of physicians who did not plan to adopt an EHR cited lack of financial resources as the reason.

"We have seen a significant increase in the adoption and use of health IT systems among providers, and the new data shows the importance of incentives in building an interoperable health IT system," said ONC National Coordinator Karen DeSalvo, M.D., in the release.

Findings Reveal Adopter Characteristics

The survey revealed nuggets of information that demonstrate the characteristics of EHR-adopting physicians. For example, with an EHR adoption rate of 77 percent, primary care physicians outpaced physicians in medical subspecialties (68 percent) and surgical specialties (63 percent).

Practice size made a difference, too. About 92 percent of physician practices with 11-plus physicians had adopted EHRs, compared with 67 percent of practices with two to three physicians, and just 47 percent of solo physicians.

Also, 86 percent of multispecialty practices used an EHR compared with just 76 percent of single-specialty practices.

Steven Waldren, M.D., director of the AAFP's Alliance for e-Health Innovation, offered some insight into the survey findings for AAFP News, noting the fact that solo physicians lag behind larger groups in adoption rates.

"Most likely, it is a financial decision and they feel that the capital and time investment is too much," said Waldren. "But the AAFP also knows that many of our solo family physicians practice in rural areas, so for some, the reluctance to invest in EHRs could stem from the lack of broadband technology in their communities as well as a shortage of experts available to provide technical assistance," he added.

The fact that primary care physicians outpace other specialty groups did not surprise Waldren given the AAFP's dedication to moving health IT issues along, beginning with the original Future of Family Medicine project(www.annfammed.org) launched more than a decade ago. From the outset, the framers of that project envisioned family physicians enhancing patient care via ever-increasing technology tools, said Waldren.

He pointed out that the Academy also created the Academy's Center for Health IT (the precursor to the new Alliance for Innovation) specifically to

  • educate family physicians about health IT and the adoption process,
  • work with health IT vendors to align products with primary care needs,
  • help develop standards to improve the value of health IT and
  • focus on advocacy to direct the industry in ways that would ease the burden of health IT implementation by family physicians.

The fact that family physicians boast an EHR adoption rate between 70 percent and 80 percent is significant, said Waldren.

"Family medicine as a specialty draws innovators and adventurous people to be family physicians, and the specialty is, by its very nature, information-intensive," he said. "These dynamics have supported a more rapid adoption of the technology in family medicine than in any other specialty," he added.

HHS Touts Financial Incentives

In their summary, researchers highlighted the positive impact of the government's carrot-and-stick approach.

"There was a clear difference in the influence of financial incentives and payments among physicians who adopted prior to HITECH passage and after," wrote the authors. In fact, 62 percent of physicians who adopted an EHR between 2010 and 2013 said that financial incentives and penalties "played a significant role" in their decision to adopt an EHR, compared with 23 percent of physicians who adopted an EHR before HITECH."

As further evidence, more than one-third of physicians who had not yet implemented an EHR said they either had applied, or planned to apply, for incentive funds. That information, according to the authors, indicated those physicians had "a clear plan to adopt an EHR."

Authors noted, however, that 10 percent of physicians were not eligible for an incentive payment through CMS' EHR incentive program.

"Moreover, a majority of physicians who did not plan to adopt an EHR also cited a lack of financial resources as the reason for that decision," said the authors.

Moving Toward Interoperability

Researchers pointed out that more than 30 percent of physicians -- both adopters and nonadopters -- said the ability to exchange patient information electronically with other health care professionals would most certainly influence their EHR adoption decisions.

Importantly, noted the researchers, close to 10 percent of surgical specialists surveyed said they would never adopt an EHR. And that statistic could point to trouble ahead.

"To ensure that physicians have enough trading partners with whom to safely and securely exchange information, adoption must be high across all providers groups," said the researchers. "Physicians across the spectrum must adopt EHRs and use them to safely and securely share patient health information electronically."

As for Waldren, he agreed that EHR interoperability was the next big frontier. And he pointed out that the AAFP is again on the frontlines, digging in and doing the hard foundational work.

"The AAFP has helped to define the clinical data standards and as well as the standards for exchange in work known as the Direct Project(directproject.org)," said Waldren. "We're also diligently working to drive into the marketplace adoption of secure email for health care," he added.

Related AAFP News Coverage
Q&A With Steven Waldren, M.D.
Quest for EHR Usability, Interoperability Fuels AAFP's Technology Team


Meaningful Use Requirements
AAFP, Others Urge Timeline Flexibility in EHR Incentives