Elsevier

Healthcare

Volume 2, Issue 1, March 2014, Pages 33-39
Healthcare

EHR adopters vs. non-adopters: Impacts of, barriers to, and federal initiatives for EHR adoption

https://doi.org/10.1016/j.hjdsi.2013.12.004Get rights and content

Abstract

While adoption of electronic health record (EHR) systems has grown rapidly, little is known about physicians' perspectives on its adoption and use. Nationally representative survey data from 2011 are used to compare the perspectives of physicians who have adopted EHRs with those that have yet to do so across three key areas: the impact of EHRs on clinical care, practice efficiency and operations; barriers to EHR adoption; and factors that influence physicians to adopt EHRs. Despite significant differences in perspectives between adopters and non-adopters, the majority of physicians perceive that EHR use yields overall clinical benefits, more efficient practices and financial benefits. Purchase cost and productivity loss are the greatest barriers to EHR adoption among both adopters and non-adopters; although non-adopters have significantly higher rates of reporting these as barriers. Financial incentives and penalties, technical assistance, and the capability for electronic health information exchange are factors with the greatest influence on EHR adoption among all physicians. However, a substantially higher proportion of non-adopters regard various national health IT policies, and in particular, financial incentives or penalties as a major influence in their decision to adopt an EHR system. Contrasting these perspectives provides a window into how national policies have shaped adoption thus far; and how these policies may shape adoption in the near future.

Introduction

In 2008, about 40% of US physicians used some type of electronic health record (EHR) system, but fewer than 20% had an EHR with a basic set of computerized features, including the ability to record information on patient demographics, view laboratory and imaging results, maintain problem lists, compile clinical notes, and manage computerized prescription ordering.1, 2 These early adopters reported that EHRs improved timely access to medical record, quality of communication with other providers and tasks such as prescription refills. Physicians who had not adopted EHRs reported major barriers to doing so, including capital costs, finding a system that meets practice needs, uncertainty about return on investment, and concerns that the EHR system would become obsolete.3

National policies and programs that are now in place through the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 seek to address many of these barriers and encourage physicians to adopt and meaningfully use EHRs in order to experience their potential benefits.4, 5 The Medicare and Medicaid EHR Incentive Program provides physicians financial incentives for the adoption and meaningful use of EHRs and penalties for non-adoption. A certification program seeks to ensure that EHRs meet meaningful use requirement standards. The Regional Extension Center Program assists physicians with key steps of the adoption process including selecting an EHR and providing technical assistance with EHR implementation.6 State-level initiatives and federal projects in partnership with the private sector have been funded to enable the electronic exchange of clinical information amongst providers.7

In 2012, over three quarters of physicians had adopted some type of EHR.8 Physician adoption of EHRs with at least “basic” computerized functionality has grown since the passage of the HITECH Act, reaching 40% in 2012.8

In this new environment where EHR adoption has spread beyond the earliest adopters to over half of all physicians little is known about physicians' perspectives on EHR adoption and use. Recent surveys of physicians' attitudes and experiences with EHR adoption have been conducted within states such as Massachusetts, Texas and Florida, but these studies do not provide a national level physician perspective.9, 10, 11 One national study, found physicians with systems that met meaningful use in late 2011/early 2012 were more likely to rate panel management as easy compared to those not meeting the standard.12 Further understanding of the national experiences of physicians who have adopted EHRs to date and the perceptions of physicians who have yet to do so post-HITECH can inform ongoing policies and programs designed to support continued EHR adoption and to ensure that physicians are informed of the potential benefits of EHRs once they begin using them.

This study compares the perspectives of physicians who have and have not adopted EHRs in three key areas: the experienced or expected impact of EHRs on clinical care, practice efficiency and operations; barriers to EHR adoption; and the influence of major policy initiatives that seek to increase EHR adoption. Contrasting these perspectives provides a window into how national policies have shaped adoption thus far; and how these policies may shape adoption in the near future.

Section snippets

Data sources

Data from two nationally representative surveys of non-federal office-based physicians in the United States were used: (1) the 2011 National Ambulatory Medical Care Survey (NAMCS) Electronic Medical Records (EMR) mail survey from which we obtained physicians' office characteristics and whether or not they used an EHR, and (2) the 2011 NAMCS Physician Workflow Survey (PWS), a follow-up mail survey to the 2011 NAMCS EMR survey that asked physician respondents about their attitudes and experiences

Impacts of EHRs

After controlling for physician and practice characteristics, a large proportion of physicians regardless of their EHR adoption status agreed that the use of EHRs led to positive impacts on clinical care, practice efficiency and finances (Fig. 1). Specifically, significantly more EHR adopters compared to non-adopters perceive that EHR use produces clinical benefits (84% vs. 69%), more efficiencies (76% vs. 65%), and financial benefits (61% vs. 52%) for the practice. Although non-adopters were

Discussion

This study provides a national portrait of physicians' perspectives and experiences using and adopting EHRs. The majority of physicians, regardless of EHR adoption status, agree that EHR use results in overall clinical benefits, more efficient practices, and financial benefits. Among non-adopters, purchase cost and productivity loss are major barriers to EHR adoption; and MU financial incentives and penalties, technical assistance, and the capability for electronic health information exchange

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