The results of a 2015 Medical Economics survey on health information technology shows the surprising result that smaller, independent practices are not at a disadvantage in IT. They may actually be leading the way.
The conventional wisdom is that small, independent primary care practices are at a disadvantage in the digital world, because they have fewer resources with which to purchase, support, and upgrade EHRs than do large multispecialty groups and hospital-owned practices. But the results of the 2015 Medical Economics survey on health information technology turn that assumption on its head. They indicate that, in some respects, small primary care groups are in the vanguard of health IT.
The survey respondents include a broad range of physicians in different practice settings. But 53% of them are primary care doctors; by comparison, only a third of practicing U.S. physicians are generalists. Fifty-one percent of the respondents work in practices of one to four physicians; in contrast, nearly 60% of the nation’s physicians practice in groups of one to nine doctors. So the 2015 Medical Economics Physician EHR Survey sample is skewed to smaller and primary care practices.
Considering these features of the sample, it might seem counterintuitive that 48% of the physicians who had EHRs said they had attested to Meaningful Use Stage 2. According to the latest figures from the Centers for Medicare and Medicaid Services, just 56,658 eligible professionals-mostly doctors--had attested in stage 2 as of July 2015. Applying the government’s estimate that 78% of office-based physicians have EHRs to the total number of practicing doctors, one can calculate that fewer than 10% of doctors with EHRs of any kind (though possibly somewhat more with certified EHRs) have attained stage 2 meaningful use.
What this comparison suggests is that primary care doctors in small practices might have a greater interest than other physicians in achieving meaningful use. One possible explanation is that the remaining EHR incentive money and the penalties for not attesting to meaningful use motivated the primary care physicians more than it did higher-earning specialists and doctors in larger groups.
It is also easier for physicians who are experienced and comfortable with their EHRs to meet the meaningful use criteria. Here primary care doctors have the advantage, having adopted EHRs earlier, on average, than did other kinds of specialists. This is one reason why primary care doctors tend to be more satisfied with their EHRs than are other kinds of specialists, according to a recent survey by AmericanEHR Partners and the AMA. The researchers noted that it takes an average of three years for physicians to get used to working with EHRs.
In the AmericanEHR survey, which reflects the broad population of physicians, only 34% of respondents said they were satisfied with their EHRs, many fewer than in previous years. By contrast, 51% of the Medical Economics respondents-just slightly less than in 2014-said they were somewhat or very satisfied with their EHR.
If there is a correlation between satisfaction and length of use, the higher percentage of respondents in our survey who were satisfied with their EHRs may be related to the fact that 29% of respondents with EHRs had their systems for five to nine years, and 32% had them for three to four years.
What all of these data point to is a simple fact that the pundits seem to have missed: The size of a practice and its resources matters less to EHR success than the motivation of its physicians.
Ken Terry is an award-winning healthcare journalist specializing in health information technology. He is a contributing editor for Medical Economics.