A substantial proportion of physicians are unsure about or are not planning to participate in a government program that provides economic incentives to implement and use electronic health records. Those physicians tend to be older than others, and in smaller, independent practices.
If and when they do implement EHR, they may require extensive support in selecting and using electronic systems.
Writing in the March 2015 issue of the Annals of Internal Medicine, Catherine DesRoches, PhD., Mathematica Policy Research, Cambridge, Mass., reported results of surveys in 2011, 2012 and 2013 of 3,400 primary care and specialist physicians. The researchers’ primary goal was to measure associations between the stage of EHR adoption and practice characteristics.
Among the findings:
- In 2011, 44 percent of physicians had an EHR that met basic criteria. (These were considered “early adopters,” according to DesRoches.)
- Between 2011 and 2013, an additional 19 percent adopted a basic EHR (“new adopters”).
- In 2013, 20 percent were in the process of implementing an EHR or had implemented one without some functions required for a basic EHR (“partial implementers”). Eight percent were planning to adopt an EHR in the next two years (“planners”), and 9 percent were not planning to adopt an EHR (“persistent non-adopters”).
- Persistent non-adopters were, on average, older than other physicians.
- The mean number of physicians employed in the main practice location of persistent non-adopters was 2.3, compared with 33.4 among early adopters and 15.1 among new adopters.
- Persistent non-adopters were significantly more likely to be employed in independent solo or two-physician practices than early and new adopters, who were significantly more likely to be employed by a hospital or medical school, group or staff-model HMO, or network owned by a hospital or other type of healthcare organization.
- Most persistent non-adopters reported fee-for-service as their primary compensation, whereas early and new adopters were more likely to report salary adjusted for performance.
- Persistent non-adopters seemed less likely to participate in incentive programs focused on improving the quality and continuity of care and were 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.
“Persistent non-adopters in small, isolated practices may be facing a unique set of challenges that limit their ability to adopt an EHR,” writes DesRoches. “Failure to address the needs of these physicians has implications beyond adoption, because new models of healthcare delivery require the use of an EHR.
“Physicians who choose not to make the change to EHRs may find themselves further isolated if these new models become widespread, but they may move toward adoption as the penalty phase of the meaningful use program draws closer. If so, they are likely to require extensive support in selecting, implementing, and using these systems.”