CDC data on EHR adoption overlooks inconvenient facts


The U.S. Department of Health & Human Services last week boasted that the percentage of doctors who had basic electronic health records doubled between 2008 and 2011. That's certainly a good sign. So is the increase in the percentage of physicians who say they plan to show Meaningful Use. More than half of doctors now say they aim to attest to Meaningful Use, vs. 41 percent in 2010.

But it's way too early to break out the champagne. To start with, the Centers for Disease Control and Prevention (CDC), which conducted the physician EHR survey, dropped the category of "fully functional" EHRs that it had used in previous years. It's now looking only at how many doctors have basic systems and how many say they have any "EMR/EHR" system at all. (That's so vague that it's virtually meaningless.) Why the comprehensive EHR category was eliminated is anyone's guess; but it's a good bet that the CDC did it to make the numbers look better.

In any case, here's how CDC's National Center for Health Statistics defined a basic EHR in its paper on the 2011 survey: "A system that has all of the following functionalities: patient history and demographics, patient problem list, physician clinical notes, comprehensive list of patient's medications and allergies, computerized orders for prescriptions, and ability to view laboratory and imaging results electronically."

That definition leaves out a number of functions that comprehensive EHRs were supposed to have, including drug interaction checking, the ability to send prescriptions online to pharmacies, the ability to order lab and imaging tests, and guideline-based interventions such as reminders for preventive and chronic care. While the basic EHR criteria do match some of the core requirements for Meaningful Use, the inability to send prescriptions electronically would prevent a basic EHR adopter from attesting to Meaningful Use.

CDC statistics show that in 2009, 21.8 percent of physicians had basic EHR systems and 6.9 percent had comprehensive systems. Preliminary data for 2010 reveal that 24.9 percent of respondents had basic EHRs and 10.1 percent had fully functional systems. In 2011, the CDC reports, 33.8 percent of doctors had basic EHRs. Even after factoring in the accelerated rate of growth in previous years, no more than 15 to 20 percent probably had comprehensive EHRs.

And that's only one problem with the survey results. As consultants recently reminded me, many physicians use only a small fraction of their EHR's capabilities. For example, while their staff members may input problem lists, allergies, and vital signs, the doctors may refuse to enter any data into the EHR. Some of them dictate or type their notes, creating large blocks of non-searchable free text. In some cases, they continue to handwrite their notes, using the EHR alongside their paper charts--a hugely inefficient approach. Their EHRs may not have lab interfaces, either because they can't afford them or because they're unobtainable. And they're not online with pharmacies because they haven't set up that functionality, or because it's not part of their EHR.

The financial incentives tied to Meaningful Use probably will increase the appropriate use of EHRs over time. But unless physicians buy more capable systems, there won't be much they can do with them. And, without guideline-based prompts and registries to ensure patients receive proper preventive and chronic care, EHRs will not help physicians achieve the Triple Aim of healthcare reform: to lower cost, improve quality and provide a better patient experience. - Ken

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