Electronic Health Records: Status, Needs and Lessons

Medical Group Management Association® (MGMA®) publications are intended to provide current and accurate information and are designed to assist readers in becoming more familiar with the subject matter covered. Such publications are distributed with the understanding that MGMA does not render any legal, accounting or other professional advice that may be construed as specifically applicable to individual situations.

No representations or warranties are made concerning the application of legal or other principles discussed by the authors to any specific factual situation, nor is any prediction made concerning how any particular judge, government official, or other person will interpret or apply such principles. Specific factual situations should be discussed with professional advisors. Production Credits Project Manager: James W. Margolis, MPA, FACMPE Managing Editor: Bob Redling Cover Design: Deidre Adams ISBN: 978-1-56829-387-5 Copyright © 2011 Medical Group Management Association. All rights reserved.

No part of this publication may be reproduced, stored in a retrieval system or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior written permission of the copyright owner. Electronic Health Records: Status Needs and Lessons – 2011 Report Based on 2010 Data Snapshot of an Infrastructure under Construction Introduction The number of medical practices and other organizations using electronic health record (EHR) systems in the United States has increased measurably over the past decade, but use of this technology remains far from universal.

The Centers for Disease Control’s National Center for Health Statistics estimates that only a small fraction of the 43. 9 percent of office-based physicians using an EHR in 2009 had fully functional systems with the capability to record clinical notes, prescriptions, laboratory results, and imaging results. To better understand the current state of EHR use by physicians, the Medical Group Management Association (MGMA) undertook a study in 2010 to explore the barriers to EHR adoption and the experiences of health care organizations that have progressed through the implementation process and optimized use of their EHRs.

This study was funded by PNC Bank. The timing of this study gains greater urgency as it was completed shortly before the January 2011 introduction of monetary incentives to physicians and hospitals through the federal Health Information Technology for Economic and Clinical Health (HITECH) Act — part of the American Recovery and Reinvestment Act (ARRA) of 2009. MGMA queried its members and customers, asking them about the use of EHR and other information technology in their organizations. Data was collected between Oct. 1 and Nov.

9, 2010, and this report examines the information reported by the 4,588 healthcare organizations that responded to the survey. The responses came from a wide variety of organizations (see Figure 1: Responses by Organization Type) and represent the aggregate experience of more than 120,000 physicians in medical practice. What we are learning about how physicians and organizations successfully adopt and optimize the use of EHR technology may bring more clarity to barriers that have, so far, prevented wide use of this technology. Copyright © 2011.

Medical Group Management Association. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without prior written permission of the copyright owner. 1 Investigation method In reaching these conclusions, we analyzed questionnaire responses from independent medical practices (59. 2 percent of respondents) and medical practices with hospital or IDS ownership (17. 4 percent of respondents).

Additional responses came from medical school faculty practice plans or academic clinical departments (4. 6 percent), federally qualified or community health centers (2. 8 percent), and other types of organizations. Figure 1: Responses by Organization Type 59. 2% Independent medical practice Hospital or integrated delivery system (IDS) or medical practice owned by hospital or IDS Medical school faculty practice plan or academic clinical science department Federally qualified health center, community health center or similar practice 2. 8%

Healthcare consulting, legal or accounting firm 2. 4% Physician practice management company (PPMC) 2. 1% Freestanding ambulatory surgery center (ASC) 1. 4% Management services organization (MSO) 1. 5% Independent practice association (IPA) 0. 9% Urgent care center 0. 7% 17. 4% 4. 6% 7. 0% Other 0% 20% 40% 60% 80% Analysis approach The survey utilized a convenience sample method that limits its ability to describe the extent of EHR adoption among medical practices. However, the method permits an analysis of specific segments of the respondents, such as by stage of EHR implementation.

With this focused snapshot, we hope to provide a deeper, qualitative look at the use of EHR technology at the inception of the federal government’s multibillion dollar effort (HITECH Act) to promote widespread use of EHR. About our analysis. While some observers of EHR adoption may focus on practice size, our study also sheds light on another influential factor: practice ownership. As fewer physicians are opting for independent practice and more are employed by hospitals and IDSs, an analysis of the differences in EHR implementation and use by practice owner is increasingly important.

Therefore we describe several of our findings by practice ownership type; in particular, we focus on contrasts between independent physician practices and those owned by a hospital or IDS. Copyright © 2011. Medical Group Management Association. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without prior written permission of the copyright owner.