Combined data from two surveys of U.S. physicians taken over the past two years shows that while there has been a marked increase in the number of doctors using electronic health records (EHR), the overall number of fully-functional systems remains in the high single digits to low double digits as a percentage of physicians.
Preliminary estimates from the 2010 National Ambulatory Medical Care Survey (NAMCS), which is conducted by the U.S. Centers for Disease Control (CDC), showed that the percentage of physicians with EHRs that met the criteria of a basic EHR system by state ranged from 12.5% to 51.5%.
However, after excluding 27 states with unreliable estimates, the percentage of physicians having systems that met the criteria of a fully functional system across the United States ranged from 9.7% to 27.2%.
A comparison of 2009 and 2010 surveys showed the number of physicians with systems that met the criteria of a basic or a fully functional system increased by 14.2% and 46.4%, respectively.
The federal government has been using a carrot and stick-approach to prod physicians and hospitals into deploying EHRs that meet its "meaningful use" criteria.
Physicians may receive as much as $44,000 under Medicare and $63,750 under Medicaid, and hospitals may receive millions of dollars for implementation and meaningful use of certified EHRs under both Medicare and Medicaid.
Those that don't implement EHRs by 2015 will begin being penalized through cuts in Medicare payments. Phase I of its meaningful use criteria -- all 864 pages of it -- was released last year. Phases II and III are expected out by the end of this year and 2013, respectively.
Currently there are 23 measures proposed that hospitals must implement before the end of this year to gain the maximum amount of reimbursement under the American Recovery and Reinvestment Act.
Dr. Tom Handler, a radiologist and analyst for the research firm Gartner, said one of the main barriers to adoption, "valid or not," are concerns about the productivity and usability of EHR systems. Many physicians also believe that the data collected by the government through EHR reporting criteria will be used to decrease Medicare and Medicaid reimbursements, Handler said.
"Ultimately, what I hear doctors saying is, 'Let me get this straight. You want me to spend money to put in a system that will be harder to use and slow me down, so I will earn less money, and that the end result is that someone else makes more money," Handler said. "If you phrase it that way, it's not illogical to see why they don't want to do it."
E-prescribing is another example. "Docs say, 'I didn't go to medical school to become a data entry clerk so Walgreens could hire one less pharmacy tech to enter the system.'"
Handler said current meaningful use criteria also doesn't take aim with incentives that address what physicians consider some of the most critical reforms needed in healthcare today.
For example, Handler said, a computer-based patient record system can catch duplicate patient test orders, but the current meaningful use incentives don't penalize physicians for ordering duplicate tests.
Ultimately, it's the patient -- the insurance company and then society -- that pays for the duplicate test, and yet, its the physician who'll have to foot the cost for the system that can prevent the duplicate tests, he said.
Dr. Harry Greenspun, chief medical information officer for Dell and a member of the Healthcare Information and Management Systems Society (HIMMSS), said resistance to EHR adoption can be as simple as a physician not wanting to add steps to a process that has worked for decades.
"It's really easy to write a prescription; you just jot it down on note paper. On a computer screen it can take a lot longer," he said. "If you go have to through a check list or a menu-driven program, it can be clunky, and a barrier to adoption."