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National Survey of Physicians in Annals of Internal Medicine
Finds Adoption of Electronic Health Records Is Increasing, but Significant Challenges Remain
Many Doctors Are Not Able to Use More Advanced Clinical Management Functions or Share Information with Patients
Contact: Jennifer de Vallance, (202) 484-4692
CAMBRIDGE, MA—June 4, 2013—More than 40 percent of the nation’s physicians have access to a basic electronic health record (EHR) system, according to a study in the Annals of Internal Medicine led by Catherine M. DesRoches of Mathematica Policy Research and Karen Donelan at the Mongan Institute for Health Policy at Massachusetts General Hospital. However, at the time the survey was taken, only 10 percent had access to a system that would meet the meaningful use criteria of the Centers for Medicare & Medicaid Services (CMS) for EHRs. CMS established these criteria to ensure that physicians use EHRs to improve patient care. Physicians participating in the meaningful use program receive financial incentives as the criteria are met.
The study, “Meeting Meaningful Use Criteria and Managing Patient Populations,” sponsored by the Commonwealth Fund (CMWF) and the Robert Wood Johnson Foundation (RWJF), was based on a 2012 national survey of physicians. It found that, although adoption of EHRs is increasing, significant challenges remain.“To meet the meaningful use criteria requires that physicians use their EHRs as more than a substitute for a paper record. Doctors will need to use EHRs to measure and assess the care they provide, as well as manage their patient populations,” says Dr. DesRoches, the paper’s lead author. “Our findings suggest that the tools for these tasks are not widespread and are complicated and difficult to use.”
One-third or fewer physicians in the study had computerized systems for generating lists of patients by lab result (31 percent) or the need for follow-up care (34 percent); listing patients’ race, ethnicity, or preferred language (33 percent); providing patients with after-visit summaries (33 percent); sending reminders for follow-up care (31 percent); or tracking patient referrals (28 percent).
Dr. Donelan, the paper’s senior author, says, “We are seeing physician practices in the midst of a sometimes painful transition. Our nation has made a major investment in encouraging the use of electronic health records. Some physicians see definite progress, others are still waiting to see if the gains justify the costs.”
Physicians’ opinions were decidedly mixed about the effect of the increased use of EHRs on health care in the United States. More than half believed that increased use of this technology would have a positive effect on health care quality (57 percent) and efficiency (51 percent), but only one-third (33 percent) said the same about its effect on the cost of care.
Methodology
The first round of the CMWF/RWJF National Panel Survey of Physicians was conducted by Harris Interactive from October 19, 2011, to March 16, 2012. The sample was drawn from the members of the American Medical Association and included physicians board certified in adolescent medicine, family practice, geriatric medicine, general practice, general preventive medicine, internal medicine, or selected subspecialties. Physicians were contacted by mail up to four times and offered $35 as an incentive to participate. To meet the target sample goal, all physicians who did not respond were sent the fourth mailing and offered an additional $45. Questionnaires were received from 1,820 physicians (a 60 percent response rate). The second round of the survey is currently being conducted.
The meaningful use criteria the survey measured include:
- Ordering prescriptions electronically
- Maintaining a patient’s active medication list
- Recording and charting changes in vital signs
- Recording patients’ smoking status
- Providing warnings of drug interactions or contraindications
- Reminding clinicians to provide guidelines-based interventions
- Exchanging laboratory and diagnostic test results with physicians outside your practice
- Exchanging patients’ clinical summaries with physicians outside your practice
- Generating quality metrics
- Providing patients with electronic copies of their health information
About Mathematica: Mathematica Policy Research seeks to improve public well-being by conducting studies and assisting clients with program evaluation and policy research, survey design and data collection, research assessment and interpretation, and program performance/data management. Its clients include foundations, federal and state governments, and private-sector and international organizations. The employee-owned company, with offices in Princeton, NJ; Ann Arbor, MI; Cambridge, MA; Chicago, IL; Oakland, CA; and Washington, DC, has conducted some of the most important studies of health care, international, disability, education, family support, employment, nutrition, and early childhood policies and programs.
About Massachusetts General Hospital: Massachusetts General Hospital, founded in 1811, is the original and largest teaching hospital of Harvard Medical School. The hospital conducts the largest hospital-based research program in the United States, with an annual research budget of more than $775 million and major research centers in AIDS, cardiovascular research, cancer, computational and integrative biology, cutaneous biology, human genetics, medical imaging, neurodegenerative disorders, regenerative medicine, reproductive biology, systems biology, transplantation biology, and photomedicine. In July 2012, it moved into the number one spot on the 2012–2013 U.S. News & World Report list of America’s best hospitals.