EHRs widely used but fall short of federal standards

SAN FRANCISCO – California physicians are finding themselves cornered in an EHR catch-22, a new report finds. The data shows that although a majority of the state’s physicians now use EHRs – technology pushed by the federal government – most of the implemented systems fail to meet new federal meaningful use requirements.  

The report, conducted by the University of California at San Francisco (UCSF) in conjunction with the California Medical Board and the California Department of Health Care Services, comes as a disappointment for the state's medical community. 

“We found that physicians are more likely to have electronic health records with functions that support individual patient visits rather than functions that support overall quality improvement,” said lead author Janet M. Coffman, assistant professor at the UCSF Philip R. Lee Institute for Health Policy Studies and UCSF Department of Family and Community Medicine.

Coffman pointed out that 61 percent of the surveyed physicians use EHRs that enable them to record clinical notes but only 45 percent are able to generate routine reports of quality indicators, such as the percentage of patients with diabetes who receive recommended lab tests, foot exams, and eye exams.

The research also showed the size of a physician’s practice to be the strongest predictor of having an EHR. Physicians who practice in Kaiser Permanente, other large medical groups, the Department of Veteran Affairs, or the military are much more likely to have EHRs than physicians in smaller practices.

Core objectives, menu objectives and electronic reporting on the quality of care are identified by federal regulations as the three categories of objectives aimed at achieving meaningful use of the technology. 

To encourage increased adoption of EHRs, incentive payments will be provided to hospitals and providers that achieve meaningful use of the technology.

The Health Information Technology for Economic and Clinical Health (HITECH) Act incentive payments could total up to $27 billion over 10 years, or as much as $44,000 (through Medicare) and $63,750 (through Medicaid, called Medi-Cal in California) per clinician. This funding also will provide the basis for the creation of a nationwide network of EHRs.

“The Medicare and Medicaid incentive payments will provide valuable resources to physician practices that do not yet have EHRs that will meet meaningful use standards,” said Coffman.  “Medicaid payments especially are important since we found that community health centers, rural health clinics, and other practices that primarily serve Medicaid beneficiaries and uninsured persons are less likely to have EHRs. Many of these practices are struggling to keep their doors open. Medicaid incentive payments give these practices an opportunity to purchase EHRs.”

This report summarizes a survey of California physicians about their current use of EHRs and their eligibility for the Medi-Cal EHR incentive program.

Some key findings:

Although 71 percent of physicians surveyed have an EHR system, only 30 percent have EHRs configured to meet all 12 of the meaningful use objectives measured in the study.Rates of EHR availability are lowest among physician solo practitioners, small partnerships, and community/public clinics. Office-based physicians are less likely to have EHRs than those in hospitals, and rural physicians are less likely to have them than urban physicians.Most physicians who, based on their survey responses, are eligible for incentive payments (70 percent) do not currently have EHRs that can meet all 12 of the meaningful use objectives measured.Many physicians are not familiar with the eligibility rules for the Medi-Cal EHR incentive payment program. A substantial percentage of survey respondents who are eligible for the payment program believe that they are not eligible, do not plan to apply, or need further information before deciding to apply. At the same time, a number of respondents who plan to apply do not appear to be eligible.