Elsevier

Healthcare

Volume 3, Issue 1, March 2015, Pages 38-42
Healthcare

Do family physicians electronic health records support meaningful use?

https://doi.org/10.1016/j.hjdsi.2014.11.002Get rights and content

Abstract

Background

Spurred by government incentives, the use of electronic health records (EHRs) in the United States has increased; however, whether these EHRs have the functionality necessary to meet meaningful use (MU) criteria remains unknown. Our objective was to characterize family physician access to MU functionality when using a MU-certified EHR.

Methods

Data were obtained from a convenience survey of family physicians accessing their American Board of Family Medicine online portfolio in 2011. A brief survey queried MU functionality. We used descriptive statistics to characterize the responses and bivariate statistics to test associations between MU and patient communication functions by presence of a MU-certified EHR.

Results

Out of 3855 respondents, 60% reported having an EHR that supports MU. Physicians with MU-certified EHRs were more likely than physicians without MU-certified EHRs to report patient registry activities (49.7% vs. 32.3%, p-value<0.01), tracking quality measures (74.1% vs. 56.4%, p-value<0.01), access to labs or consultation notes, and electronic prescribing; but electronic communication abilities were low regardless of EHR capabilities.

Conclusions

Family physicians with MU-certified EHRs are more likely to report MU functionality; however, a sizeable minority does not report MU functions.

Implications

Many family physicians with MU-certified EHRs may not successfully meet the successively stringent MU criteria and may face significant upgrade costs to do so.

Level of evidence

Cross sectional survey.

Introduction

The adoption of electronic health record (EHR) technology by primary care practices has increased in recent years,1, 2 in conjunction with incentives from the Centers for Medicare and Medicaid Services (CMS) for the “meaningful use” of certified health information technology (HIT) products.3, 4 However, success in meeting the policy priorities of “meaningful use” and realization of the projected cost savings from EHR technology have remained elusive.5, 6 The federal meaningful use (MU) program was born of the Health Information Technology for Economic and Clinical Health (HITECH) Act, with the goal of promoting “the spread of electronic health records to improve health care in the United States”.7 Incentive programs for MU for eligible professionals, and standards and certification criteria for EHR vendors and their products increased adoption of certified EHR technology (CEHRT).

The MU program claims that the benefits will be complete and accurate information, better access to information, and patient empowerment. The implementation plan for MU was conceived as three progressive stages that focus on (1) data capture and sharing, including initial quality reporting and sharing data for care coordination, (2) advanced clinical processes, including comprehensive information exchange across settings, and (3) improved outcomes, including measuring and improving quality for patients and populations and patient access to self-management tools. Though vendors may incorporate specific, required MU functionality in their products, the implementation of the system by a practice or a third-party implementation team can potentially block access to or render unusable these functions during the clinical workflow. Alternately, such additional functions may be packaged as “add-ons” with additional fees to purchase and implement. Thus, it is unclear how many certified EHRs currently in use actually deliver expected MU functions.

From 2005 to 2011 the percentage of U.S. family physicians using an EHR in ambulatory practice nearly doubled from 37% to 68%.1 However, previous national surveys during this time found that only one-third of physicians had an EHR that met MU criteria.8, 9 There is real concern that broad adoption of EHRs by family physicians prior to MU certification may leave practices at risk for having EHRs that are not capable of supporting the advancing functions required in MU Stage 2 and MU Stage 3. As such, these practices may be required to make significant investments in EHR upgrades or even purchase and implement entirely new systems that results in substantial cost, effort, and disruptions to practice and patient care. Currently, it remains unclear if the previously reported trends in the adoption of EHR technology by family physicians have been accompanied by MU functionality. The objective of our study was to characterize family physician access to MU functions when MU Stage 1 criteria were just starting in 2011.

Section snippets

Data and sample

We used data from a two-week survey conducted by the American Board of Family Medicine (ABFM) in fall 2011. Any physician who accessed their secure online portfolio during this time was redirected to a brief survey before entering their portfolio, yielding a 100% response rate. For this analysis our inclusion criteria included residence in the United States and having practice demographic and characteristics data available. These data were obtained from the ABFM demographic data which are

Results

Of the 5818 physicians who completed the survey, 3855 (66%) had demographic data available and were located within the 50 United States. Compared to other physicians in the ABFM database likely to access their portfolio during the survey period, survey respondents were slightly younger and were more likely to be female (data not shown). The majority of respondents were 40–60 years old (less than 5% were <40 years old), 35.5% were female, and 14.5% were IMGs (Table 2). Nearly half of respondents

Discussion

Family physicians who report having an EHR that supports MU are more likely to report MU capabilities. However, a sizeable minority of these physicians lacked key MU capabilities in 2011, which may limit their ability to meet more stringent MU Stages 2 and 3 standards. These early adopters of EHR technology may need to make a sizeable reinvestment or upgrade of existing software in order to meet more stringent MU standards.

Though there are some demographic differences between our study sample

Conflict of interest

None.

Funding

No external sources of funding.

Acknowledgments

Ms. Nichole Lainhart provided copy editing assistance with the manuscript.

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    Family physicians provide nearly 20% of all clinical outpatient visits, nearly 200 million visits in the United States annually.1 Frontline clinicians continue to report failures of certified electronic health records (EHRs) to meet federal certification requirements and to meet electronic reporting needs, the latter of which is estimated to cost them $15 billion per year.2–11 Reducing reporting burden and enhancing the portability and utility of clinical data for quality improvement is an American Board of Family Medicine (ABFM) goal that is aligned with federal policy.12,13

1

Was at American Academy of Family Physicians, Leawood, KS, USA during the writing of the manuscript.

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