Here's a Look at Who's Eschewing EHR Implementation

Researchers Offer Insight on 'Persistent Nonadopters'

March 12, 2015 02:15 pm News Staff

Physicians who have not adopted electronic health records (EHRs) tend to be older, work in independent solo or two-physician practices, and are less likely than their colleagues who have embraced technology to participate in incentive programs linked to quality improvement.

[Two doctors looking at laptop]

Furthermore, according to researchers at Mathematica Policy Research in Cambridge, Mass., physicians dubbed "persistent nonadopters" also are "significantly less likely than early and new adopters to receive or have the potential to receive additional payments for managing patients with chronic conditions or complex needs."

Such were the findings( of project co-director Catherine DesRoches, Dr.P.H., and her colleagues, who analyzed EHR adoption rates among U.S. primary care physicians, as well as those among certain subspecialists who were most likely to provide health care to patients over extended periods of time.

Survey results were highlighted in a letter titled "Progress and Challenges in Electronic Health Record Adoption: Findings From a National Survey of Physicians" and published in the March issue( of Annals of Internal Medicine.

Survey Specifics

Authors surveyed( 3,437 physicians during two time periods -- between October 2011 and March 2012 and between May 2013 and July 2013. Researchers based their findings on physicians who responded to both rounds of the survey and noted a 44 percent overall response rate.

Story Highlights
  • Researchers surveyed physicians about electronic health records (EHRs) and found that EHR nonadopters tend to be older than their EHR-savvy colleagues and work in independent solo or two-physician practices.
  • Persistent nonadopters also are less likely than early or new adopters to receive additional payments for managing patient with chronic conditions or complex health needs.
  • Authors concluded that physicians without EHRs will find themselves further isolated in a health care system that is moving forward with payment models that rely on health IT and will need significant help catching up with implementation.

Specifically, among physicians who participated in the survey

  • 44 percent had implemented an EHR in 2011 that met basic criteria (early adopters),
  • 19 percent adopted a basic EHR between 2011 and 2013 (new adopters),
  • 20 percent were in the EHR implementation process in 2013 or were using an EHR that lacked certain functions required for a basic system (partial implementers),
  • 8 percent said they would implement an EHR within two years (planners), and
  • 9 percent were not planning to adopt an EHR (persistent nonadopters).

According to the authors, "The mean number of physicians employed in the main practice location of persistent nonadopters was 2.3 compared with 33.4 among early adopters and 15.1 among new adopters."

Furthermore, "Methods of compensation varied by stage of implementation," noted the authors.

"Most persistent nonadopters reported fee-for-service as their primary compensation, whereas early and new adopters were more likely to report salary adjusted for performance."

Assisting Nonadopters

Researchers pointed out that the U.S. health care system increasingly relies on its health IT infrastructure and that physicians using EHRs can earn substantial incentive payments made available through the Health Information Technology for Economic and Clinical Health (HITECH) Act.

They expressed concern that nonadopters -- most often found in small and isolated practices -- faced "a unique set of challenges" that limited their ability to embrace EHRs.

"Failure to address the needs of these physicians has implications beyond adoption because new models of health care delivery require the use of an EHR," said researchers. Physicians who resist EHR adoption stand to further isolate themselves and their practices as those new models become the norm.

In addition, physicians who belatedly join their colleagues in the EHR inner circle likely will require much hand-holding as they begin to shop, implement and learn the intricacies of using a robust EHR system in a busy primary care practice, said the authors.

Researchers predicted a possible surge in EHR interest among nonadopters as the penalty phase of CMS' EHR meaningful use program approaches.

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