U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICESCenters for Disease Control and Prevention

National Center for Health Statistics

Progress in use of electronic medical Progress in use of electronic medical records by office-based physicians in records by office-based physicians in

20062006

by Esther Hing, M.P.H., and Catharine W. Burt, Ed.Dby Esther Hing, M.P.H., and Catharine W. Burt, Ed.DAnnual meeting Academy HealthAnnual meeting Academy Health

June 10, 2008June 10, 2008

ObjectivesObjectives

•Examine progress in use of electronic medical record (EMR) systems among office-based physicians since 2001. •Focus on changes in use between 2005 and 2006•Examine plans to install new EMR system or replace current system within the next 3 years

National Ambulatory Medical Care Survey

•Annual nationally-representative surveys of office-based physicians

•3,350 in 2006•Scope: Nonfederal office-based physicians excluding radiologists, anesthesiologists, and pathologists•Face-to-face induction interview•Response rates for data presented ~64%•NAMCS estimates based on

•1,311 physician responses in 2006

Benchmark use of health Benchmark use of health information technologyinformation technology

Does your practice use electronic medical records?

•Yes, all electronic •Yes, part paper, part electronic•No•Don’t know

Question on electronic medical records use:

Percent of office-based physicians using EMRsPercent of office-based physicians using EMRs

29.2

23.9

20.8

17.317.318.2

0

5

10

15

20

25

30

35

2001 2002 2003 2004 2005 2006

Pe

rce

nt

of

ph

ys

icia

ns

SOURCE: CDC/NCHS, National Ambulatory Medical Care Survey, 2001-2006

Diffusion of EMRs among physicians by practice sizeDiffusion of EMRs among physicians by practice size

0

5

10

15

20

25

30

35

40

45

50

2001-02 2003-04 2005-06

Per

cen

t o

f p

hys

icia

ns

NOTES: Office-based physicians include nonfederal, office-based physicians who see patients in an office setting. Excludes radiologists, anesthesiologists, and pathologists.

Sources: National Ambulatory Medical Care Survey , 2001-2006

Solo

Partner

3-5 physicians

6-10 physicians

11 or more physicians

Percent of Office-Based PhysiciansPercent of Office-Based PhysiciansUsing Selected EMR Features: 2006Using Selected EMR Features: 2006

66.2

52.946.5

63.7

34.028.9

18.0

26.3

14.6 11.9 9.513.1

Warning foradverse drug

effects

Rx sent topharmacy

electronically

Test orderssent

electronically

Clinicalreminders

Full EMR Partial EMR All physicians

Source: National Ambulatory Medical Care Survey, 2006

Percent of Office-Based PhysiciansPercent of Office-Based PhysiciansUsing Selected EMR Features: 2005-2006Using Selected EMR Features: 2005-2006

23.921.4

17.7

13.4

17.2

12.7

5.4

29.226.2

22.9

19.5 20.4

16.2

6.6

2005

2006

1/ Trend is statistically significant (p<0.05).Source: National Ambulatory Medical Care Survey, 2005- 2006

Percent of office-based physicians using any EMR and minimally Percent of office-based physicians using any EMR and minimally functional EMRfunctional EMR

29.2

9.3

12.4

23.9

20.8

17.317.318.2

0

5

10

15

20

25

30

35

2001 2002 2003 2004 2005 2006

Pe

rce

nt

of

ph

ys

icia

ns

NOTES: EMR is electronic medical record. Trend for any EMR is significant (p<0.05). SOURCE: CDC/NCHS, National Ambulatory Medical Care Survey, 2001-2006

Any EMR

Miinimally functional EMR

Percent of office-based physicians using minimally Percent of office-based physicians using minimally functional EMR systemsfunctional EMR systems by physician specialty typeby physician specialty type

9.28.5

10.3

14.3

12.1

9.2

0

2

4

6

8

10

12

14

16

Primary care/1 Surgical Medical

Pe

rce

nt

of

ph

ys

icia

ns

2005 2006

1/ Trend is statistically significant (p<0.05).SOURCE: CDC/NCHS, National Ambulatory Medical Care Survey, 2001-2006

Percent of office-based physicians using minimally Percent of office-based physicians using minimally functional EMR systemsfunctional EMR systems by percent of revenues from by percent of revenues from

MedicaidMedicaid

11.110.1

5.5

9.8

12.913.6

0

2

4

6

8

10

12

14

16

Under 5% 5-19% 20% or more/1

Per

cen

t o

f p

hys

icia

ns

2005 2006

1/ Trend is statistically significant (p<0.05).SOURCE: CDC/NCHS, National Ambulatory Medical Care Survey, 2001-2006

Percent of office-based physicians using minimally Percent of office-based physicians using minimally functional EMR systemsfunctional EMR systems by geographic regionby geographic region

3.4

7.5

9.3

16.7

7.5

14.0

8.7

21.1

0

5

10

15

20

25

Northeast/1 Midwest/1 South West

Pe

rce

nt

of

ph

ys

icia

ns

2005 2006

1/ Trend is statistically significant (p<0.05).SOURCE: CDC/NCHS, National Ambulatory Medical Care Survey, 2001-2006

Physicians planning new or replacement EMR systems within next 3 yearsPhysicians planning new or replacement EMR systems within next 3 years

25.3

23.0

44.1

46.2

12.9

18.911.9

17.7

0% 20% 40% 60% 80% 100%

No or unknown

Some EMR

Percent distribution

Yes Maybe No Unknown or blank

NOTES: EMR is electronic medical records. Excludes physicians currently using minimally functional EMR systems. SOURCE: CDC/NCHS, National Ambulatory Medical Care Survey, 2006

Physicians planning new or replacement Physicians planning new or replacement EMR Systems within next 3 years by geographic EMR Systems within next 3 years by geographic

region region

15.322.9

16.2 12.7

24.8

26.7

27.9

17.6

0

10

20

30

40

50

60

Northeast Midwest South West

Pe

rce

nt

of p

hys

icia

ns

Yes

Maybe

NOTE: Excludes physicians using minimally functional EMR systems. Source: National Ambulatory Medical Care Survey, 2006.

40.1

49.6

44.1

30.3

ConclusionsConclusions

• Use of electronic medical records between 2001 Use of electronic medical records between 2001 and 2006 increased by 60% among office-based and 2006 increased by 60% among office-based physicians.physicians.

• Measurement of EMR systems by included Measurement of EMR systems by included functionalities started in 2005. Based on functionalities started in 2005. Based on presence of four key features, only 1 in 10 presence of four key features, only 1 in 10 office-based physicians used minimally office-based physicians used minimally functional EMR systems during 2005-2006functional EMR systems during 2005-2006

ConclusionsConclusions

• In 2006, 35-43% of physicians not currently using a In 2006, 35-43% of physicians not currently using a minimally functional EMR system planned to install or minimally functional EMR system planned to install or

replace their current system within the next three yearsreplace their current system within the next three years; ; an additional 12-17% of physicians considered doing soan additional 12-17% of physicians considered doing so. .

• Based on physician report of plans to install or replace Based on physician report of plans to install or replace current EMR systems, EMR use in 2009 may increase to current EMR systems, EMR use in 2009 may increase to 42%, at a minimum, or 54% at a maximum.42%, at a minimum, or 54% at a maximum.

• These projections are consistent with diffusion theory These projections are consistent with diffusion theory projections (Ford, Menachemi, Phillips, 2006). projections (Ford, Menachemi, Phillips, 2006).

Policy implicationsPolicy implications

• Based on our study-based and diffusion theory Based on our study-based and diffusion theory projections, electronic health record (EHR) use projections, electronic health record (EHR) use by office-based physicians will fall short of the by office-based physicians will fall short of the federal goal of widespread use by 2014.federal goal of widespread use by 2014.

• Continued efforts by the Office of National Continued efforts by the Office of National Coordinator for Health Information Technology Coordinator for Health Information Technology and other organizations are needed to promote and other organizations are needed to promote universal adoption of functional EMR systems. universal adoption of functional EMR systems.