Smaller practices hit roadblock to electronic health record adoption

Fewer than 15% of medical group practices in the U.S. use an electronic health record. High costs and system complexity are making adoption most difficult for smaller offices, according to a study conducted by the Medical Group Management Association Center for Research and the University of Minnesota School of Public Health.

"The most surprising finding of our study was just how complex and difficult it is for a practice to find and select an EHR that will meet its needs," said coauthor Dr. Terry Hammons, senior vice president of research at the MGMA.

The Assessing Adoption of Health Information Technology project, which was funded by the Agency for Healthcare Research and Quality, queried more than 3300 medical group practices.

Smaller practices have the most difficult time implementing an EHR, and for many it isn't even on their radar. The researchers reported that only 12.5% of medical group practices with five or fewer physicians have adopted an EHR.

Those numbers increased with practice size:

• 15.2% adoption for practices with six to 10 physicians

• 18.9% for practices with 11 to 20 physicians

• 19.5% for groups with 20 or more physicians

Not only is EHR adoption proving to be slow going throughout the country, it also takes time to get everyone in a single organization online. Only 11.5% of practices queried reported that they had an EHR implemented for all physicians in all practice locations.

The researchers were surprised at the extent to which the benefits of an EHR are limited by how few other entities - labs, hospitals, and imaging facilities that could potentially link electronically to a practice's EHR - are actually connected, Hammons said.

The study revealed other data:

• 12.7% of groups were in the process of implementing an EHR.

• 14.2% planned implementation within the next year.

• 19.8% planned implementation within 13 to 24 months.

• 41.8% had no immediate plans for EHR adoption.

Nearly half of the practices with no immediate plans to adopt an EHR were groups with fewer then five full-time physicians. For groups with more than 21 physicians, only 20.7% reported that they had no plans to adopt an EHR.

Hammons and colleagues asked a number of questions about what smaller facilities need in terms of implementing an EHR.

"The most important potential 'accelerators' fall into the categories of helping the practices deal with the substantial financial costs of implementation, including decreased productivity, and helping the practices with the complex tasks of identifying good systems to consider and figuring out which would best meet their needs," Hammons said.

Findings are reported in the September/October edition of Health Affairs (Gans D et al. Medical groups' adoption of electronic health records and information systems. 2005;24(5):1323-1333).