This document summarizes electronic health record (EHR) adoption trends among ambulatory care physicians from 2005 to 2010. It defines ambulatory care, EHRs, and levels of EHR adoption. Charts show EHR adoption rates increasing over time but meaningful use adoption rates remaining low at 6%. The document concludes that new financial incentives and regulations under HITECH are aimed at increasing meaningful EHR adoption rates.

1. Ambulatory
Electronic Health Records
Adoption Trends
2005-2010
Jessica Jacobs
September 15, 2010

2. What does Ambulatory Mean?
• Ambulatory providers are physicians who
perform the majority of their services outside
the hospital
– No more than 90% of their services are
performed at a hospital
• Currently there are 200,0000 physician
offices, 515,000 total practicing ambulatory
physicians*
https://questions.cms.hhs.gov/app/answers/detail/a_id/9844/~/[ehr-incentive-program]-are-physicians-who-practice-in-hospital-based
Note: Excludes radiologists, pathologists, anesthesiologists, ER and all other hospital-based physicians

3. In other words…
Them Not Them

4. What is an EHR?
• An Electronic Health Records (EHR) is “a longitudinal electronic record of patient
health information generated by one or more encounters in any care delivery setting.
Included in this information are patient demographics, progress
notes, problems, medications, vital signs, past medical
history, immunizations, laboratory data and radiology reports.” – HIMSS, 2010
• Colloquial Definition – Computer records in a doc’s offices
that can talk to pharmacies, has decision support, talks to
hospitals, improves quality, decreases costs, and saves the world

5. Adoption Definitions
44% 21% 6%
•Any EHR •Patient •All Basic
Basic
Full
Any
Adoption Demographics Requirements
•Problem Lists •Medical
•Clinical Notes History/Follow
•Rx Orders Up
•Lab Results •Test Orders
•Imaging •Rx/Test Orders
Results sent
Electronically
•Drug/Drug
Interactions

6. EHR Adoption Rates
Accenture, Any (Small Practices)
50.00%
xxx, Any (Internal Medicine)
45.00%
Kemper, Any (Pediatricians)
40.00%
Modern Medicine, Any (PCP)
35.00%
NAMCS, Any
30.00%
Simon et al, All (Physician Practices)
25.00%
SK&A, Any
20.00%
DesRoches, Basic (All Physicians)
15.00% NAMCS, Basic
10.00% Accenture, Full (Small Practices)
DesRoches, Full
5.00%
NAMCS, Full
0.00%
2004 2005 2006 2007 2008 2009 2010 2011

7. Adoption Definitions
44% 21% 6%
•Any EHR •Patient •All Basic
Basic
Full
Any
Adoption Demographics Requirements
•Problem Lists •Medical
•Clinical Notes History/Follow
•Rx Orders Up
•Lab Results •Test Orders
•Imaging •Rx/Test Orders
Results sent
Electronically
•Drug/Drug
Interactions

8. HITECH… and Meaningful Use
• The Health Information Technology for Economic and Clinical
Health (HITECH) Act of 2009 was a part of ARRA
• Allocated funds to spur the adoption of electronic health records
- mostly administered through ONC and CMS
• Incentive Payments for Meaningful Use are administered through
CMS
– Medicare: Maximum Incentive = $44k/physician
– Medicaid: Maximum Incentive = $63k/physician
– Incentives will be paid 2011- 2016, then penalties will begin
• Meaningful Use Rules were released July 13, 2010

9. Basically…

10. EHR Adoption Rates
50.00% Accenture, Any (Small Practices)
xxx, Any (Internal Medicine)
45.00%
Kemper, Any (Pediatricians)
40.00%
Modern Medicine, Any (PCP)
35.00%
NAMCS, Any
30.00%
Simon et al, All (Physician Practices)
25.00%
SK&A, Any
20.00%
DesRoches, Basic (All Physicians)
15.00%
NAMCS, Basic
10.00% Accenture, Full (Small Practices)
5.00% DesRoches, Full
0.00% NAMCS, Full
2004 2005 2006 2007 2008 2009 2010 2011

11. Key Take-Aways
• The rates of ambulatory adoption have risen
significantly over the past five years
• Unfortunately that increase in adoption has
not translated into “meaningful” adoption
• The current rate of meaningful adoption is
6.3%, hopefully new rules and certifications
will help increase this percentage