EHR adopters vs. non-adopters: Impacts of, barriers to, and federal initiatives for EHR adoption
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
References (20)
- et al.
Physicians in nonprimary care and small practices and those age 55 and older lag in adopting electronic health record systems
Health Aff
(2012) - et al.
Electronic health record systems and intent to apply for meaningful use incentives among office-based physician practices: United States, 2001–2011
NCHS Data Brief
(2011) - et al.
Electronic health records in ambulatory care—a national survey of physicians
N Engl J Med
(2008) Launching HITECH
N Engl J Med
(2010)Implementation of the federal health information technology initiative
N Engl J Med
(2011)- et al.
The regional extension center program: helping physicians meaningfully use health information technology
Ann Intern Med
(2010) - et al.
From the Office of the National Coordinator: the strategy for advancing the exchange of health information
Health Aff
(2012) - et al.
Use and characteristics of electronic health record systems among office-based physician practices: United States, 2001–2012
NCHS Data Brief
(2012) - et al.
Physician and practice characteristics associated with longitudinal increases in electronic health records adoption
J Healthcare Manag/Am Coll Healthcare Exec
(2011) - et al.
Assessing differences between physicians' realized and anticipated gains from electronic health record adoption
J Med Syst
(2011)
Cited by (51)
The adoption of the e-portfolio management system in the Technical and Vocational Training Corporation (TVTC) in Saudi Arabia
2023, International Journal of Information Management Data InsightsElectronic health records: Three decades of bibliometric research productivity analysis and some insights
2022, Informatics in Medicine UnlockedCitation Excerpt :The pros and cons of EHRs have been reported in many research studies over the last twenty years. The adoption rate has also increased progressively [9]. Recent studies have reported an adoption rate of 88% [10] in the United States of America.
Web-based patient portal access in an orthopedic adult reconstruction patient population
2019, Arthroplasty TodayCitation Excerpt :The Health Information Technology for Economic and Clinical Health (HITECH) Act passed in 2009 along with the Medicare and Medicaid EHR Incentive Program provides financial incentives for physician and hospital use of EHRs and penalties for not using them [1-6]. Jamoom et al. [22] surveyed physicians on their adoption of EHR finding that over 70% of physicians were influenced by financial incentives or penalties. These incentives have likely contributed to the widespread adoption of EHRs across US hospitals [1].
Barriers and challenges to Primary Health Care Information System (PHCIS) adoption from health management perspective: A qualitative study
2019, Informatics in Medicine Unlocked