Electronic Health Records


California survey shows low certified EHR use

By Kyle Murphy, PhD

- Last week, the California HealthCare Foundation (CHCF) released its survey of California physicians using electronic health records (EHRs) and participating in the Centers for Medicare & Medicaid (CMS) EHR Incentive Programs. Unsurprisingly, “On the road to meaningful use of EHRs: A survey of California physicians” confirms what we already know to this point.

1. Few physicians are satisfied with their EHRs. Physicians with EHRs certified for meaningful use report greater satisfaction with their systems than those without.

2. Solo practices and community hospitals lag seriously behind large hospital systems despite the fact that the former have a higher rate of eligibility for EHR incentives.

3. EHR use in urban areas (73%) outpaces use in rural areas (58%) although the latter are where most Medicaid recipients are.

4. Physicians under the age of 46 are more likely to use an EHR (78%); those over 46 are less likely (62%).

5. A minority of physicians intends to demonstrate meaningful use; the largest percentage of physicians reported that they either had no intention of doing so or were uninformed.

What may come as a surprise is the high number of physicians who report having an EHR: 71%. This puts California physicians well ahead of the national average of 57%, as reported by the Centers for Disease Control (CDC) in February. Yet any enthusiasm should be tempered by the realization that only a much smaller percentage has an EHR certified for meaningful use:

While EHRs are widely available in California physicians’ practices, this survey suggest that many are not currently configured with all the functions needed to meet CMS objectives for meaningful use. Although 71% of physicians report that they have some sort of EHR, only 30% report that they have EHRs that can meet all 12 of the meaningful use objectives measured in the study.

At this point in the EHR Incentive Programs, this reality may not seem a big deal — what physicians without a certified system miss out on are reimbursements.  If we fast-forward a few years when penalties come into play, we’ll then realize the significance of have an uncertified EHR. The enforcement period is slated to begin in 2015 with adjustments to Medicare payments from 99% in 2015, 98% in 2016, so on and so forth.

Unless providers actively review their systems in light of meaningful use standards regardless of their intention to collect incentives, there could be a great amount of scrambling by the time CMS gets around to taking names. For instance, take a scenario offered in the survey of a physician who believes her EHR can meet the objectives of meaningful use but the system wasn’t configured correctly.

Given the number of certified EHRs (more than 300) and emphasis on certification by the Office of the National Coordinator for Health Information Technology (ONC) and CMS, having an EHR system will not be enough to avoid penalties. But will the penalties be enough to necessitate providers to choose certified solutions? While information about incentives is abundant, information about penalties is scarce. At the point questions will arise about what it means to demonstrate meaningful use to avoid fines and who’s responsible for paying. If the criteria for penalties are the same as the incentives, then the use of a certified EHR is a must.

Despite the high level of EHR use, the survey of California physicians indicates a need for both information pertaining to (1) why more eligible professionals are not applying for meaningful use and (2) what the consequences of not having a certified EHR system will be.

For all the talk, there seems to be too little information.

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