2011 EHR Adoption Rates

On Wednesday the Centers for Disease Control and Prevention (CDC) released the results of its yearly survey on Electronic Health Records (EHR) adoption for office-based physicians. No surprises. Generally speaking, the majority of physicians in ambulatory practice are now using an EHR, and over half of surveyed doctors say that they intend to seek Meaningful Use incentives. The report is also presenting results broken down by state, so you can learn what folks are doing in your immediate vicinity. The more instructive exercise is to compare last year’s survey results [Fig. 1] to this year’s estimated EHR adoption numbers [Fig. 2].

Figure 1: Percentage of office-based based physicians with EHR – 2010
Figure 2: Percentage of office-based physicians with EHR – 2011


The most immediate observation is that 6.2% of physicians have adopted an EHR in 2011, thus returning to EHR growth rates preceding the 2009 -2010 slowdown, which was largely due to the confusion created by Meaningful Use regulations. The next observation is that the percentage of docs that have at least a basic EHR has gone up by 8.9% in 2011. A basic EHR is one that has “patient history and demographics, patient problem list, physician clinical notes, comprehensive list of patient’s medications and allergies, computerized orders for prescriptions, and ability to view laboratory and imaging results electronically”. Although the survey instrument in 2011 did ask about more advanced functionality, and is practically identical to the 2010 instrument, the CDC did not publish a separate number for those with fully functional systems in 2011. Although I cannot be certain, I would assume that most of the growth in 2011 was fueled by certified EHRs, which by definition should be fully functional. So if I had to guess, and I hope CDC will release the numbers so I don’t have to, I would estimate that in 2011 we have at least 20% of physicians using fully functional systems, which is roughly double what we had in 2010.

Another interesting trend that has been holding since around 2007 is that about a quarter of office-based doctors have some type of bare bones software in their office and they are not upgrading to even a basic EHR. Considering that over half of those surveyed intend to apply for Meaningful Use incentives, this trend is bound to change in 2012.  Some of these folks may have purchased a fully featured EHR, but chose to either not turn features on or chose not to keep up with upgrades to newer versions. For ambulatory EHR vendors these numbers translate into a market opportunity ranging from 50% of the market to a full 80% of ambulatory physicians.

It would be very beneficial if CDC released the complete data set from this survey (anonymised, of course), so we could gain a better understanding of EHR adoption patterns by practice type, size and location. Although it is widely acknowledged that larger practices and employed physicians are further along the curve, the rich details provided by the survey instrument should help both vendors and various organizations engaged in efforts to spur technology adoption, better target their work, and it could also illuminate any disparities which may affect quality of care for vulnerable populations and physicians who serve them.

In summary, the new CDC survey is showing a stable growth in technology use by office-based physicians, modestly improved by government initiatives over the last two years, and well positioned to further improve in 2012 and beyond.

Margalit Gur-Arie was COO at GenesysMD (Purkinje), an HIT company focusing on web based EHR/PMS and billing services for physicians. Prior to GenesysMD, Margalit was Director of Product Management at Essence/Purkinje and HIT Consultant for SSM Healthcare, a large non-profit hospital organization. She shares her thoughts about HIT topics and issues at her blog, On Healthcare Technology.

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19 replies »

  1. Was wondering if there are any recent statistics on the number or percentage of CEs and EPs who are switching from one EHR to a different one – anybody know?

  2. There is a national average of 12% error rate with eRx, similar to paper. The problemas at Brown’s teaching hospitals is that all 2000 got to the patients; more thousands of the same errors from the devices’ defect are occurring at other hospitals that used the same device (no disclosure by the vendor); and, this was going on for 15 months before anyone picked it up.

    This raises notice of a common phenomena of the “output must be correct cognitive satisfaction cause the computer did it”.

    Sad, those users were and are mindless, which is part of the medical care landscape I see arising from these complex user unfriendly devices that cause insidious and pervasive errors.

    It remains a travesty that these devices are being sold in violation of the F D and C Act because Sebelius says it is ok and political pressures have kept the FDA from doing its job.

  3. These devices are error promoting disruptors of clinical wrokflow.

    It behooves the CDC to do its real job (about diseases) to look at these devices as iatrogenic diseases, and gather the data of near misses, injuries, and deaths associated with these devices in hospitals and in clinics.

    After two decades of chearleading by ONC (8 years), vendors, and lobbyists in disguise such as Newt, is it not shocking that the IOM concludes that no one knows whether these devices are safe cause there has not been any meaningfully truthful surveillance?

    Actually, there are accurate reports coming from the users (and lawsuits) who have had to deal with the premature deaths and life changing injuries due to the errors from HIT.

    2000 eRx errors from the Brown teaching hospitals…oh my oh my!,

  4. Relatedly:

    CMS just released the most recent data on Meaningful Use reimbursements to date (actually through Oct).

    Texas EPs and hospitals have thus far gotten 20% of the $1.24 billion thus far paid out nationally ($247.5 million in TX). Of that, 83% went to the Medicaid side ($205.6 million).

    Texas comprises ~8% of U.S. population.

    On the Medicaid side all you have to do for Year One Stage One is attest to “A/I/U” — Adopt / Implement / or Upgrade to a CHPL Certified system. You don’t have to report on any MU measures, which is why vendors such as Practice Fusion are touting the “free money” aspect of it.

    Maddeningly to me, CMS has yet to report on the relative proportions of EHR vendors whose clients have attested to date. We ran that all the way up the internal flagpole and got blown off — they’ll release those tabulations in “Q2 or Q3 or 2012.”

    No vendor opacity politics there, ‘eh?

  5. I don’t know if it is worth the pain. We are told that it is, or rather that it will be some day.

    I know many people are complaining about EHRs not being “ready for prime time” and as MD as HELL above implies, not having good functionality, so here is hypothetical question:
    If the government made an EHR, like the one rbaer is using, available to all physicians for FREE (no small print and no hidden charges), and if the government would pay each physician, say, $100,000 per year for using said EHR, would you folks still think it’s a bad idea, or would you sign up for the program within 24 hours of the announcement?

    • I would sign up without the incentive, but then I already use a free EHR.
      There is no sound reason for not doing exactly as you describe – give away the SAME EHR to everyone. The reasons this is not done tell you all you need to know about why true reform is going to be so difficult to achieve within our current corrupt political system.

      • My son just sent me this in an email, and I know it’s overkill, but…..

        “”I stand for the square deal. But when I say that I am for the square deal, I mean not merely that I stand for fair play under the present rules of the game, but that I stand for having those rules changed so as to work for a more substantial equality of opportunity and of reward for equally good service….

        “Now, this means that our government, National and State, must be freed from the sinister influence or control of special interests…. For every special interest is entitled to justice, but not one is entitled to a vote in Congress, to a voice on the bench, or to representation in any public office. The Constitution guarantees protection to property, and we must make that promise good. But it does not give the right of suffrage to any corporation.

        “The true friend of property, the true conservative, is he who insists that property shall be the servant and not the master of the commonwealth; who insists that the creature of man’s making shall be the servant and not the master of the man who made it. The citizens of the United States must effectively control the mighty commercial forces which they have called into being.”

        –Theodore Roosevelt, August 31, 1910

        • “The true friend of property, the true conservative, is he who insists that property shall be the servant and not the master of the commonwealth; who insists that the creature of man’s making shall be the servant and not the master of the man who made it. The citizens of the United States must effectively control the mighty commercial forces which they have called into being.”

          Among the Founding “Truths” held to be “Self-Evident,” I find it lamentable that they did not explicitly declare the fundamentally implicit. to wit:

          That markets properly exist to serve humanity, not the other way around. For, if you disagree, then you believe — however unreflectively — that Might Makes Right.

        • I’m sorry, but this quote, in reply to my statement about a corrupt political system, implies the opposite of truth. To believe that the current occupants of congress will ever “effectively control the mighty commercial forces” is to believe in fantasy. You can rant all you want about the evils of the corporate world, but the corporate world will never change until congress changes – it has to happen in that order. Occupy Wall Street should have been Occupy Congress, that might have started something that was actually more than just an entertainment piece on the 6 o’clock news.
          Who is more at fault, the one who passes the law that says it is illegal to bribe, and then accepts a bribe anyway,or the one who gives the bribe?
          It has gone so far beyond redemption that the usual talk about electing someone to “clean up congress” is just stupid. Your democratic champions of social justice happen to be some of the most corrupt people on the planet, standing shoulder to shoulder with their equally corrupt republican counterparts.
          The ony chance we have (and it is a very slim one) is to demand common sense laws – to reject options that hit a few high points that we happen to like but that on the whole continue the trend of showering favors on the corporate donors. Until congress feels the wrath of the people, all this talk of reining in the evil corporations is just meaningless banter.

          • Actually, Dr. Mike, this is exactly what that quote was supposed to convey – the stark difference between political leadership then and now, and maybe an indication to the type of people we need to elect.

  6. It does exist, I am using one in the hospital and (by the same vendor. modified) in the office. It is a huge effort – from programmers, legions of IT service people, users who have to learn the whole thing and users who notice that they have to redo something because they do it exactly right the first time. I believe it’s huge progress to have the medical history/notes and x-rays always available because we are part of a larger system, but is e.g. computerized order entry worth the pain? Hard to tell.

    • The term “fully functional” was defined by CDC to include some 16 advanced capabilities in the 2009-2010 survey, which were closely aligned with Meaningful Use, but not quite enough to satisfy Meaningful Use requirements.

    • There are no shortages of oponiins when the phrase EMR or EHR is mentioned. The reality is they are needed and it’s time to automate our healthcare delivery system. The other facts are there are 500+ EMR/EHR vendors most limping along with old technology that was developed 20 years ago, Unix based and very early Microsoft designed products. Stimulus will extend the life of those products. These vendors, including all of the largest, thats right all of the largest public companies, have not sold enough product to invest in a re-write to more current technology. Now add in the fact that physicians are buried in workload every day of their lives, it’s difficult for them to long range plan or take the time to evaluate the multitude of product available. I just spent a year evaluating product, and there are less than 5 vendors who utilize new technology, allowing the physician to modify the templates on the fly, and who utilize very intuitive standards so the physician can pick up the tablet and use it with just an hour or two of training. One last criteria to always consider is that the EMR/EHR has at least 2,000 doctors already using the product, bleeding edge technology will never work in a busy medical practice. I have 25 years of experience in medical software and I’ll tell you that after Stimulus is over, 50%+ of the doctors will end up with a workable EMR/EHR that will be sunset with a new chargeable version replacement by 2015 to 2020. That’s a real shame because physicians will be back on the treadmill paying for the next level of technology that is already available today. Simple questions will point to the best solution; Is it browser based technology? (make sure it’s not Citrix or WTS ). Does it have the ability to modify templates on the fly? Is the patient portal built in at no charge? Do you have over 2,000 physicians using the product? (not nurses or staff but physicians). These are just a few questions that if you get 4 yes’s you are with one of the better vendors.Good Luck and hope you find the right EMR/EHR for your practice.

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