This report was revised on January 11, 2013, after a problem was found with the weighting of the 2011 survey data.
NCHS Data Brief
■
No. 98
■
July 2012
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Disease Control and Prevention
National Center for Health Statistics
Physician Adoption of Electronic Health Record Systems:
United States, 2011
Eric Jamoom, Ph.D., M.P.H., M.S.; Paul Beatty, Ph.D.; Anita Bercovitz, Ph.D., M.P.H.;
David Woodwell, M.P.H.; Kathleen Palso, M.A.; and Elizabeth Rechtsteiner, M.S.
Key ndings
Data from the 2011
Physician Workow study
• In 2011, 54% of physicians
had adopted an electronic
health record (EHR) system.
• About three-quarters of
physicians who have adopted
an EHR system reported that
their system meets federal
“meaningful use” criteria.
• Eighty-ve percent of
physicians who have adopted
an EHR system reported being
somewhat (47%) or very (38%)
satised with their system.
• About three-quarters of
adopters reported that using
their EHR system resulted in
enhanced patient care.
• Nearly one-half of
physicians currently without an
EHR system plan to purchase
or use one already purchased
within the next year.
One goal of the federal 2009 Health Information Technology for Economic
and Clinical Health (HITECH) Act is to advance the use of health information
technology by providing Medicare and Medicaid incentives to physicians and
hospitals that adopt and demonstrate “meaningful use” (MU) of electronic
health record (EHR) systems (1,2). This report presents a nationally
representative prole of physician use of EHR systems.
Keywords: electronic health records • health information technology •
National Ambulatory Medical Care Survey • physician workow
Who adopts EHR systems?
• Fifty-four percent of physicians were adopters of EHR systems (see
“Denitions”). Among physicians under age 50, 64% were adopters.
Figure 1. Percentage of electronic health record system adoption, by physician age and
specialty and practice size and ownership, 2011
020406080 100
Medical
Surgical
Primary care
Academic health center
Community health center
HMO
Physician owned
11 or more physicians
3-10 physicians
2 physicians
Solo practitioner
Aged 50 and over
Under age 50
All physicians
Percent
Physician age
Practice size
Ownership
Physician specialty
54
1
64
1
49
1
29
60
62
1
86
1
49
1
100
73
69
2
48
54
2
58
1
Differences in adoption between this category and all others are statistically significant (p < 0.01).
2
Significant difference between primary care and surgical specialists (p < 0.01).
NOTES: Adoption consists of physicians who use a health record system that is all or partially electronic (excluding systems
solely for billing). The sample includes nonfederal, office-based physicians and excludes radiologists, anesthesiologists, and
pathologists. HMO is health maintenance organization.
SOURCE: CDC/NCHS, Physician Workflow study, 2011.
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About one-half of physicians aged 50 and over were adopters (Figure 1).
• Among solo practitioners, 29% were adopters of EHR systems. The proportion of
physicians who were adopters increased as the size of the practice increased, with 60% of
physicians in 2-physician practices, 62% of physicians in 3-to-10-physician practices, and
86% of physicians in practices with 11 or more physicians having adopted EHR systems
(Figure 1).
• Only 49% of physicians in physician-owned practices were adopters, whereas virtually
all physicians in health maintenance organizations, about three-quarters of physicians in
community health centers (73%), and 7 out of 10 physicians (69%) in academic health
centers had adopted EHR systems (Figure 1).
• Primary care (58%) and medical care specialists (54%) did not signicantly differ from
each other in EHR adoption, yet a greater proportion of primary care specialists had adopted
EHR systems compared with surgical specialists (48%) (Figure 1).
• No differences were observed in EHR adoption status by physician gender, race or ethnicity,
or practice location in metropolitan statistical area (data not shown).
What kinds of systems do EHR adopters use?
• About three-quarters of adopters (76%) have a system that currently meets the Centers for
Medicare & Medicaid Services (CMS) MU criteria (see “Denitions”), whereas 8% have
a system that does not meet the CMS MU criteria. About 15% of respondents are uncertain
whether their system meets MU criteria (Figure 2).
020406080
59
41
76
8
15
100
Uncertain
Does not meet
Meets
Meaningful use
criteria
3
System design
Web-based
2
Stand-alone
1
Percent of physicians with EHR
4
systems
Figure 2. Physicians’ electronic health record systems, by type and ability to meet meaningful use criteria, 2011
1
Data and application functionality delivered on-site.
2
System hosted and data stored off-site.
3
Defined by Centers for Medicare & Medicaid Services.
4
Electronic health record.
NOTES: Data represent physicians who reported having adopted EHR systems (55% of sample). The sample includes nonfederal, office-based physicians
and excludes radiologists, anesthesiologists, and pathologists. Missing values are excluded. Percentages may not sum to 100 because of rounding.
SOURCE: CDC/NCHS, Physician Workflow study, 2011.
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• More adopters have a stand-alone, self-contained, system (59%) rather than a Web-based
design system (41%) (see “Denitions”) (Figure 2).
• Although 10% of adopters were in the process of implementing their EHR system, the vast
majority of adopters (90%) reported actively using their EHR system (data not shown).
How satised are EHR users with their systems?
• The majority of physicians who have adopted an EHR system (85%) were either very
satised (38%) or somewhat satised (47%) with their system. About 15% of providers
were either very dissatised (5%) or somewhat dissatised (10%) with their EHR system
(Figure 3).
• Over two-thirds of adopters (71%) would purchase their EHR system again (data not
shown).
Figure 3. Percent distribution of electronic health record satisfaction among office-based physicians:
United States, 2011
NOTES: Data represent office-based physicians who reported having adopted electronic health record systems (55% of sample). The sample includes
nonfederal, office-based physicians and excludes radiologists, anesthesiologists, and pathologists. Missing values are excluded.
SOURCE: CDC/NCHS, Physician Workflow study, 2011.
Very dissatisfied
Somewhat
dissatisfied
Somewhat satisfied
Very satisfied
38
10
5
47
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What are the benets of having an EHR system?
• A majority of adopters reported having accessed a patient’s chart remotely (74%) and
having been alerted to critical lab values (52%) by using their EHR system within the past
30 days. A majority also reported that using their EHR system had resulted in enhanced
overall patient care (74%) (Figure 4).
Figure 4. Percentage of physicians whose electronic health records provided selected benefits: United States, 2011
NOTES: Physicians with electronic health record (EHR) systems whose systems or scope of work did not include a specified capability responded not
applicable. These responses are included in the denominator for percentages. Data represent office-based physicians who reported having adopted EHR
systems (55% of sample). The sample includes nonfederal, office-based physicians and excludes radiologists, anesthesiologists, and pathologists.
SOURCE: CDC/NCHS, Physician Workflow study, 2011.
020406
08
0
Patient-related outcomes
Physician workflow
Percent of physicians who experienced benefit within
past 30 days
Ordered fewer tests due to lab results’ availability
30
Ordered more on-formulary medications
44
Enhanced overall patient care
74
Facilitated direct communication with patient
25
Identified needed lab tests
29
Reminded to provide care meeting clinical guidelines
38
Alerted to potential medication error
43
Reminded to provide preventive care
40
Alerted to critical lab value
52
Accessed patient chart remotely
74
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Do physicians without an EHR system intend to purchase a system?
• Among nonadopters, about one-third reported having no intention to purchase an EHR
system within 12 months (32%), and one-fth reported being undecided whether to purchase
an EHR system in the next 12 months (20%). In addition, about one-half of nonadopters
reported either intending to purchase an EHR system within 12 months (26%) or having
already purchased one (21%) (Figure 5).
Figure 5. Percent distribution of intent to purchase electronic health record system among physicians lacking a system:
United States, 2011
NOTES: Data represent office-based physicians who reported not having adopted an electronic health record system (45% of sample). The sample includes
nonfederal, office-based physicians and excludes radiologists, anesthesiologists, and pathologists. Percentages may not sum to 100 because of rounding.
SOURCE: CDC/NCHS, Physician Workflow study, 2011.
21
Have purchased
system
26
In process of
selecting system or
intend to purchase
within 12 months
20
Undecided on
purchasing within
12 months
32
No intent to
purchase within
12 months
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Summary
Overall, in 2011, 54% of physicians in ofce-based practices had adopted EHRs and 46% had
not. Differences were observed between physicians who were EHR adopters and nonadopters
by age, physician specialty, practice size, and ownership. Generally, physicians under age 50
were more likely to adopt EHR systems than physicians aged 50 and over.
The proportion of
physicians who were adopters increased as the size of the practice increased. Compared with solo
practitioners where fewer than one-third of physicians adopted EHR systems, those in 2-physician
or 3-to-10-physician practices were twice as likely, and those in practices with 11 or more
physicians were nearly three times as likely
, to have adopted EHR systems. Only one-half of
those in physician-owned practices were adopters, whereas physicians employed by community
health centers, academic health centers, and HMOs were more likely to have adopted an EHR
system.
The majority of EHR adopters’ systems met CMS MU criteria, which would allow the practice
to receive incentive payments authorized by the HITECH Act. A majority of EHR adopters had
stand-alone systems rather than Web-based systems. Stand-alone systems offer faster response
times than Web-based systems, and although stand-alone systems have higher initial cost, their
maintenance costs are lower. Web-based systems have the advantage of being easy to access
wherever the Internet is available, whereas stand-alone systems may have limited off-site access.
The vast majority of physicians who use EHR systems (85%) reported being somewhat satised
(47%) or very satised (38%) with their system. A majority would purchase their EHR system
again (71%), suggesting that EHR adopters are generally positive about their current systems.
Among EHR adopters, 74% believe that using their system enhanced overall patient care.
Among nonadopters, about one-half reported either already having purchased a system or
planning to adopt a system within 12 months. This nding suggests an increase in EHR adoption
is likely to take place in 2012 among 2011’s nonadopters, potentially amplifying the impact of
federal policy incentives.
Denitions
Physician ofce: A place where physicians not federally employed provide direct patient care
in the 50 states and the District of Columbia; excludes radiologists, anesthesiologists, and
pathologists.
Demonstrating meaningful use (MU): To qualify for CMS incentive payments for MU, an eligible
provider must use a certied EHR system demonstrating all 15 of the core set objectives and 5 of
10 menu set objectives through associated measures or by attestation in 2011 (2). Comparisons of
several core objectives are available from the NAMCS supplemental EHR mail survey (3).
Adopters and nonadopters of EHRs: Status is derived from ofce-based physicians who answered
the EMR supplement question, “Does this practice use electronic medical records or electronic
health records (not including billing records)?” Adopters are those who answered either “yes,
all electronic” or “yes, part paper and part electronic”; nonadopters answered “no” to using
electronic medical records (EMRs) or EHRs.
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Stand-alone and Web-based design EHR systems: A stand-alone, or client, server represents an
EHR system that is self-contained, in which data and application functionality are delivered on-
site. Web-based EHR systems include application service providers and browser-based systems,
also called a “cloud system.” Web-based design EHR systems use a service provider to host the
system and store data for the practice off-site, and the physician accesses the EHR system and
data through the Internet (4).
Data source and methods
The data for this report are from the National Ambulatory Medical Care Survey (NAMCS)
Physician Workow mail survey. The Physician Workow study, funded by the Ofce of the
National Coordinator for Health Information Technology, is conducted by the National Center
for Health Statistics (NCHS) as a NAMCS supplement. It represents a 3-year initiative to survey
ofce-based physicians about their experiences in and perceptions of adopting and using EHR
systems. Respondents will be followed annually over a 3-year period, beginning in 2011 and
continuing through 2013.
The sample for the 2011 Physician Workow mail survey consisted of those physicians conrmed
eligible (i.e., who treat ambulatory patients in a physician’s ofce; see “Denitions”) in the
earlier 2011 NAMCS EMR mail survey. The 2011 EMR mail sample was a stratied sample of
physicians with strata dened by state. Eligible physicians for whom EHR adoption status was
not conrmed in the EMR survey were contacted to determine that status. Only those NAMCS
eligible respondents were mailed Physician Workow questionnaires within a 2-month period of
determining whether they used an EHR system. Adopters received a different questionnaire than
nonadopters (4,5).
Eligibility status was determined for 8,164 of the 10,301 ofce-based physicians in the EMR
mail survey sample, for an unweighted eligibility status rate of 79.3% (77.7% weighted). Of these
8,164 physicians, 5,232 were deemed eligible and mailed the Physician W
orkow questionnaire,
to which a total of 3,180 physicians responded for an unweighted response rate of 60.8%
(59.0% weighted). The combined, overall unweighted response rate is based on multiplying the
eligibility status rate by the workow mail response rate among those deemed eligible. Therefore,
the combined overall unweighted response rate is 48.2% (45.8% weighted). In order to be
nationally representative and correct for nonresponse bias, survey weights were designed to use
characteristics of late respondents (data obtained by phone) as a proxy for nonresponse. Those
refusing to participate in the EMR survey were contacted to determine eligibility and included
in the workow survey if eligible. About 11% of workow survey respondents had refused to
participate in the EMR survey
, with more of these respondents being nonadopters than adopters.
For estimates from the EMR questionnaire (e.g., practice size or ownership), missing estimates
include unit nonresponse among respondents who refused to take the EMR questionnaire. Among
workow survey respondents, the proportion that completed the EMR questionnaire was greater
for EHR adopters than nonadopters.
All reported comparisons are statistically signicant unless otherwise indicated. Comparisons not
mentioned may or may not be statistically signicant. Data analyses were performed using the
statistical packages SAS version 9.2 (SAS Institute, Cary, N.C.) and SUDAAN version 10.0 (RTI
International, Research Triangle Park, N.C.).
Suggested citation
Jamoom E, Beatty P, Bercovitz A, et al.
Physician adoption of electronic health
record systems: United States, 2011. NCHS
data brief, no 98. Hyattsville, MD: National
Center for Health Statistics. 2012.
Copyright information
All material appearing in this report is in
the public domain and may be reproduced
or copied without permission; citation as to
source, however, is appreciated.
National Center for Health
Statistics
Edward J. Sondik, Ph.D., Director
Jennifer H. Madans, Ph.D., Associate
Director for Science
Division of Health Care Statistics
Clarice Brown, M.S., Director
For e-mail updates on NCHS publication
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Internet: http://www.cdc.gov/nchs
ISSN 1941–4927 (Print ed.)
ISSN 1941–4935 (Online ed.)
DHHS Publication No. (PHS) 2012–1209
CS232926