Many Doctors Already Using E-Medical RecordsMany Doctors Already Using E-Medical Records

While the American Recovery and Reinvestment Act's $20 billion-plus health IT stimulus programs aims to drive e-health record adoption among healthcare providers, a new report from the Centers for Disease Control and Prevention indicates that about 4 in 10 doctor offices say they're already using these systems either partially or fully.

The National Ambulatory Medical Care Survey (NAMCS), conducted annually by the CDC's National Center for Health Statistics (NCHS), is an annual nationally representative survey of patient visits to office-based physicians that collects information on use of e-medical/e-health record systems.

CDC has been conducting the NAMCS asking about doctors' use of e-health record systems since 2001, but in 2005 started adding questions to dig into more details about the functionality of the systems, said Esther Hing, a CDC statistician involved with the 2008 and 2009 survey research.

The new CDC findings are based on a sample of 2,000 mail-in and 3,200 in-person physician surveys conducted in 2008, as well as preliminary data from similar mail-in and in-person surveys conducted in 2009. Doctors surveyed in person complete interviews conducted by Census bureau personnel.

In 2008, 2,233 doctors in total responded to the mail-in and in-person surveys, while preliminary results for the 2009 research indicate that 1,054 physicians responded to the mail-in survey. Totals for in-person surveys conducted in 2009 aren't yet available, said Hing in an interview with information.

In 2008, 41.3% of all surveyed doctor offices reported using "any EHR or EMR" system, and in 2009 that figure grew to 43.9%, based on the preliminary figures of mail-in polls only.

Although final survey statistics aren't yet available, the surveys indicate that physicians in larger practices are more likely to have EMR or EHR systems compared to doctors in smaller practices, said Hing.

The CDC said the estimates were obtained from the question, "Does this practice use electronic medical records or electronic health records (not including billing records)?"

Choices of answers included: "Yes, all electronic," "Yes, part paper and part electronic," "No," and "Don't know."

In the 2007 NAMCS, 34% of doctors reported using an EMR or EHR in their practices. The survey does not ask physicians how often they use the systems. "The survey focuses on the availability of EMR and EHR in practices and the functionality," said Hing.

Systems defined as "basic" include the following functionalities: patient demographic information, patient problem lists, clinical notes, prescription ordering, and laboratory and imaging results viewing.

Systems defined as "fully functional" include all functionalities of basic systems plus the following: medical history and follow-up, orders for tests, prescription and test orders sent electronically, warnings of drug interactions or contraindications, highlighting of out-of-range test levels, and reminders for guideline-based interventions.

In 2008, about 16.7% of physicians reported having systems that met the criteria of a basic system, and about 4.4% reported that of a fully functional system, according to the CDC report.

According to preliminary estimates from the 2009 mail survey, about 20.5% of physicians reported having systems that met the criteria of a basic system, and 6.3% reported that of a fully functional system.

Comparable figures for basic and fully functional systems in the 2007 NAMCS were 11.8% and 3.8%, respectively.

Some physicians reported their systems having functionality that did not appear on the surveys' list of choices, while other doctors did not know the functionality of their practices' EMR or EHR systems. Those doctors were not considered to be using basic or fully functional systems in the CDC findings.

"Some of these systems are older and were tailored to meet specific needs of a practice, some were off-the-shelf systems, and some doctors reported having new systems they haven't used yet," said Hing. "There are a lot of variants in the systems that have been on the market," she said.

Efforts by the U.S. government's Office of National Coordinator for Health IT to develop EMR/EHR standards and certification criteria over recent years -- and most recently as part of the ARRA's stimulus programs -- will help to get more U.S. doctors using interoperable systems with lists of functionality that can help achieve meaningful use guidelines being set, Hing said.