Saturday, July 5, 2008

Electronic medical records - Frequency of EMR Installations

What: National survey of 2758 physicians and why and why not they installed EMRs. Frequency of fully functioning EMR installations was 4% and 13% for “basic’ system. Survey measured why physicians adopted EMRs, level of satisfaction, effect of quality, and barriers to adoption.

Why: Many experts regard physician EMRs use in ambulatory care as key to improving and documenting quality of care.

When: The survey was conducted in late 2007 and early 2008 with response rate of 62%.

How: Massachusetts General and Institute of Health Policy, supported by National Coordinator of Health Information Technology. Robert Wood Johnson Foundation, and Dr. David Blumenthal, advisor to Barack Obama, led the survey team..

Who: EMRs were adopted by a few scattered primary care physicians, rarely by independent specialists, and most commonly by large groups and physicians in medical center hospital systems..

Where: Most often in Western U’S; wherelarge groups dominate.


The survey listed these positives among physicians who adopted basic and fully functional EMR systems

1. Timely access to records, 97% and 98%
2. Prescription refills, 85% and 95%
3. Quality of communication with other providers, 86% and 92%
4. Quality of clinical decisions, 63% and 82%
5. Avoiding medication errors, 80% and 86%
6. Quality of communication with patients, 59% and 72%
7. Delivery of quality care that meets guidelines, 56% and 82%.
8. Delivery of preventive care that meets guidelines, 53% and 86%.

Major Barriers

Physicians who choose not to adopt EMRs listed these major barriers. .

1. Amount of capital needed, 66%
2. Finding an EMR to fit needs, 54%
3. Uncertainty about return on investment, 50%
4. Concern system will become obsolete, 44%
5. .Concern about loss of productivity during transition, 41%
6. Capacity to select, contract, install and implement, 39%
7. Resistance from physicians, 29%
8. Concern about illegal record tampering, 18%
9. Concern about inappropriate disclosure of patient information, 17%
10. Concern about physicians’ legal liability, 14%
11. Concern about legality of accepting EMRs from hospital, 11%


Eighty three percent of American clinicians have choosen not to install EMRs. Only 4% have fully functioning systems, and a mere 13% have basic systems. Reasons for non-acceptance are mostly financial (not enough capital and low return on investment), but there are also that EMRs do not fit clinical needs, are not yet ready for prime time, may become obsolete, and pose legal and privacy hazards. Physicians who have adopted EMRs, however, have found EMRs improve quality of care and practice efficiencies.


Catherine DeRoches, et al. “Electronic Health Records in Ambulatory Care – A National Survey of Physicians, New England Journal of Medicine, July 23, 2008


Unknown said...

It's all in the definition. If by an EMR we mean that a doctor needs to use the computer to document an encounter then an EMR will never make a doctor more efficient and efficiency/productivity is the key.

Most software companies are trying to solve the wrong problem. The physician has on average 4.5 staff members according to MGMA. These folks are highly inefficient and are the doctors largest expense. Making them efficient is the key. Providing them with work flow solutions based on a paperless medical record is the answer. There is a significant ROI in this. With integrated scanning, faxing and digital input, paper can be eliminated and staff becomes more efficient (and fewer).

Would a doctor have staff share one telephone? No, but they let them chase paper around all day, stand over fax machines, etc. Staff does not the right tools. Work flow tools have been in industry for decades, now doctors offices can take advantage.

Physicians too can be more productive without having to use a computer to document an encounter. From home they can sign off on labs, op reports,refill Rx's etc. without physically handling the chart.

Dr. Scott said...

Dr. Reece
I'm researcing "the latest and greatest" for Ambulatory Care strategies. Specifically, I'm a VP of a hospital system that has many ambulatory units (urgent care, ASC's, Home Health etc...) rather randomly and haphazardly scattered throughout the community. I'm supposed to find out the "best way" to move forward with the ambulatory division. Should we go MACC vs. individual units with unified branding etc... Can you point me in the right direction? Any leaders in the field that I can contact?
Thank you!