A comprehensive study by the Medical Group Management Association (MGMA) Center for Research and the University of Minnesota School of Public Health has captured the current state of adoption of electronic health records (EHR) by U.S. medical group practices. More than 3,300 medical group practices participated in the Assessing Adoption of Health Information Technology project, which was funded by the federal Agency for Healthcare Research and Quality (AHRQ). The study reports current rates of EHR adoption, which EHR features are more frequently used, barriers to adopting an EHR and how users rated the benefits of having adopted an EHR.
Smaller Practices Report Lower Adoption Rates
The research shows that just 14.1 percent of all medical group practices use an EHR, and just 11.5 percent indicated that an EHR was fully implemented for all physicians and at all practice locations. More significantly, the research shows that only 12.5 percent of medical group practices with five or fewer full-time-equivalent physicians (FTE) have adopted an EHR. The adoption rate increased with the size of practice; groups with six to 10 FTE physicians reported a 15.2 percent adoption rate, groups with 11-20 FTE physicians reported an 18.9 percent adoption rate, and groups of 20 or more FTE physicians had a 19.5 percent adoption rate.
Other data reveals that 12.7 percent of groups were in the process of implementing an EHR; 14.2 percent said implementation is planned in the next year; and 19.8 percent said implementation was planned in 13-24 months. The remaining 41.8 percent have no immediate plans for EHR adoption. Among those with no immediate plans for implementation, the difference between large and small groups is striking�47.8 percent of practices with five or fewer FTE physicians compared with only 20.7 percent of practices with 21 or more physicians.
"Obviously, rates are low across the spectrum of all group sizes, but smaller groups face more challenges in adopting these technologies and progress more slowly than their larger counterparts," said Terry Hammons, MD, senior vice president, research and information, MGMA Center for Research, and co-author of the study. "For widespread adoption of EHRs to be successful, more work needs to be done, and small to medium size medical group practices will need more help than they are getting now."
Contributing researchers from the University of Minnesota School of Public Health Bryan E. Dowd, Ph.D., professor and director of Graduate Studies, Division of Health Services Research, Policy, and John E. Kralewski, Ph.D., professor, Division of Health Services Research and Policy, note that while some practices report important efficiency gains from their EHRs, there is widespread dissatisfaction with the design and performance of these technologies.
Nationally Representative Sample Surveyed
With funding from AHRQ, MGMA Practice Management Resources Director David N. Gans, FACMPE, Kralewski, Hammons and Dowd surveyed a nationally representative sample of medical group practices to assess their current use of information technology. They conducted the survey in January and February 2005. MGMA members made up 25 percent of the sample.
"This survey provides a guidepost for where we should focus our efforts to move the adoption of state-of-the-art electronic health record systems," said AHRQ Director Carolyn M. Clancy, M.D. "Adoption of these EHR systems is an important means to an end in our efforts to improve the quality of health care in America."
Findings of the research are also highlighted in the September/October edition of Health Affairs in "Medical Groups' Adoption of Electronic Health Records and Information Systems" written by Gans, Kralewski, Hammons and Dowd.
EHR Capabilities Vary
The report provides insight into which EHR capabilities are actually used, as not every EHR has all functions and not every medical group fully uses the capabilities of its EHR system. More than 97 percent of the respondents with an EHR reported that their system had functions for patient medications, prescriptions, patient demographic and visit/encounter notes. Less than 65 percent reported the EHR provided drug formulary information or clinical guidelines and protocols. Equally important was that only 83.1 percent of respondents said their EHR was integrated with their practice billing system.
"System integration is a highly important function of the EHR," Gans said. "Integration with the practice billing system facilitates cost savings by eliminating the manual entry of billing information, improving charge capture and improving documentation in the medical record of billed services."
Cost a Barrier to Adoption
Despite State and federal efforts to encourage adoption of these technologies, group practices cited "lack of capital resources to invest in EHR" as the top barrier to adoption. Also, University of Minnesota researchers noted, an important barrier to adoption is that practices are not convinced EHRs will improve their performance. The return on investment in terms of cost and quality are not yet evident, according to Kralewski.
The research indicates that the average purchase and implementation cost of an EHR was $32,606 per FTE physician. Maintenance costs were an additional $1,500 per physician per month. Not surprising was the finding that smaller practices had the highest per-physician implementation cost at $37,204. The study also found that the average cost for EHR implementation was about 25 percent more than initial vendor estimates.