By Whitney Blair Wyckoff, CQ Staff
June 18, 2008 -- Only a small number of physicians use a comprehensive digital record keeping system, according to a study in Thursday's online edition of the New England Journal of Medicine.
Four percent of physicians have fully functional electronic health records, or EHRs, and 13 percent have a basic system, according to the study titled "Electronic Health Record Adoption in the Ambulatory Setting: Findings from a National Survey of Physicians." Even among physicians in largest group size—where physicians are three times as likely to use basic EHR systems than their colleagues in practices of one to three—almost half did not have a digital record keeping system.
However, the study found that more physicians could be implementing such systems soon.
Sixteen percent have bought an EHR system but haven't implemented it yet, and 26 percent said their practice would purchase an EHR system within two years, the study found. This could signal an increase in usage within the next three to five years, said lead study author Catherine DesRoches during a teleconference sponsored by the Robert Wood Johnson Foundation and the Institute for Health Policy at Massachusetts General Hospital.
One of the major barriers to physicians adopting EHR is cost, DesRoches said. She said some doctors surveyed recommended the use of incentives, such as payment for purchasing or using an EHR system. The study also found that doctors view legal protection from personal liability for record tampering as important, she said.
Richard Baron, a doctor and CEO of the Greenhouse Internists group practice in Philadelphia, said it was an expensive endeavor to adopt EHR in his practice. It cost each physician in his practice $40,000 to implement, and it costs $60,000 each year in IT support, he said, adding that it took a long time to start up.
"It was not a financially rewarding thing for us to do," Baron said at the teleconference, while adding that it does help with patient care. He emphasized the need to provide incentives for practices to adopt an EHR system. "I really think new financing strategies are desperately needed," he said.
DesRoches said physicians who use the systems like them. "They're not finding them cumbersome to use, and they're not having a lot of problems with these systems going down," she said.
Last week, the Department of Health and Human Services said it plans to establish a five-year, $150 million pilot project offering incentives to 12 cities and states to encourage physicians to adopt an EHR system.
"Our findings both amplify and extend earlier work that has been done in this area," DesRoches said, adding that previous studies simply asked physicians whether they use EHR. This study differentiates between basic and more comprehensive systems, she noted.
In the more elite "fully functional" category, the EHR system must be able to record patient information and demographics, view and manage things such as lab results, manage orders—like e-prescriptions—and help with clinical decisions, such as processing reminders for screenings. Basic systems may not have certain order entry capabilities or clinical decision support.