WASHINGTON – Less than a decade ago, nine out of 10 U.S. doctors updated their patients’ records by hand and stored them in color-coded files. Today, nearly half of all office-based physicians type their clinical notes into computers and maintain electronic files that include patients’ demographic information, complaints, procedures, test results and prescribed drugs.
This greater use of electronic health records is supposed to help doctors and hospitals better coordinate their patients’ care and allow them to meet the cost-containment goals in the Affordable Care Act. Nationwide, 48 percent of office-based doctors used electronic records in 2013, up from 40 percent in 2012 and 11 percent in 2006.
While the doctors and hospitals in some states are forging ahead, in other states they are lagging behind. In North Dakota, 83 percent of physicians have made the switch to electronic records, according to a recent survey by the Centers for Disease Control and Prevention.
Minnesota ranked second, at 76 percent, followed by Massachusetts at 70 percent.
But in Maryland, Oklahoma, Vermont, West Virginia and Wyoming, the adoption rate is only 37 percent. Nevada’s rate is 33 percent, and in Washington, D.C., it is 31 percent. Connecticut and New Jersey fare even worse, at 30 percent and 21 percent, respectively.
New York’s participation rate, according to the survey, was 39.6 percent.
It’s not clear why there are such disparities among states, though researchers do know a few things about the kinds of doctors who are mostly likely to embrace electronic records.
According to a 2013 report by the Government Accountability Office (GAO), primary care doctors are nearly twice as likely to adopt electronic health records as specialists. Physicians who work alone are less likely to adopt electronic records than those in group practices, and younger doctors are more likely to embrace the change than older ones. Rural and urban doctors are equally apt to use electronic records. And of all health care professionals, dentists have the lowest adoption rate, at less than 1 percent.
Despite recent progress, the United States as a whole still lags behind other developed countries in adopting electronic records, according to a survey by The Commonwealth Fund, a health research group.
Ultimately, the Obama administration wants all U.S. doctors and hospitals to share electronic health records. But experts remain cautious about whether the current growth rate can be maintained. According to a new report from the GAO, many physicians who received federal grants to adopt or upgrade their electronic health record systems in 2011 did not continue the incentive program in 2012.
Under the Health Information Technology for Economic and Clinical Health (HITECH) Act, which was part of the 2009 economic stimulus package, the federal government set aside up to $30 billion to help doctors and hospitals make the transition to electronic records. Under the law, office-based health care professionals can receive up to $44,000 in Medicare grants in five yearly installments and $63,750 in Medicaid grants in six yearly installments. In addition, hospitals are eligible for millions of dollars under both health care programs if they develop and maintain electronic health records.
The GAO estimates $15 billion in incentive payments went to individual health care professionals and hospitals in the first two years of the program. However, the Obama administration still has not developed a way to determine whether the goals of improved health care quality, efficiency and patient safety are achieved, the GAO cautioned.
“It’s a large investment,” said Fredric Blavin, an economist at the Urban Institute, a nonprofit group that does research on economic and social issues. “Whether or not it is going to lower costs or improve patient outcomes is yet to be determined. Any changes aren’t likely until the long term – 10 or more years from now.”