261936 Miles to go on the road to meaningful use: Findings from a survey of the availability of electronic health records in California physicians practices

Monday, October 29, 2012

Janet Coffman, MA, MPP, PhD , Philip R. Lee Institute for Health Policy Studies, UCSF, San Francisco, CA
Kevin Grumbach, MD , Family and Community Medicine, UCSF, San Francisco, CA
Margaret Fix, MPH , Philip R. Lee Institute for Health Policy Studies, UCSF, San Francisco, CA
Leon Traister, BS , Philip R. Lee Institute for Health Policy Studies, UCSF, San Francisco, CA
Andy Bindman, MD , Departments of Medicine, Health Policy, and Epidemiology and Biostatistics, UCSF, San Francisco, CA
  
Background: The HITECH Act authorizes Medicare and Medicaid to make incentive payments to clinicians and hospitals for use of electronic health records (EHRs) to improve health care delivery.

Objective/Purpose: A survey of physicians was conducted to identify factors associated with having any EHR and with having an EHR that meets the Centers for Medicare and Medicaid Services' (CMS) objectives for meaningful use of EHRs.

Methods: A two-page questionnaire was mailed to a sample of physicians (MDs) renewing their California medical licenses. The survey results were combined with information from other databases maintained by the Medical Board of California. Multivariable logistic regressions were estimated to determine whether age (<46 years, 46-65 years, >65 years), gender, specialty (primary care vs. specialist), location (urban vs. rural), office-based vs. hospital based practice, large vs. small practice (>50 MDs vs. <50 MDs), and having a high percentage of patients (>30%) who were uninsured or enrolled in Medicaid or the State Children's Health Insurance Program (SCHIP) were correlated with having any EHR at a physician's main practice location and with having an EHR that can meet meaningful use objectives.

Results: Physicians in large group practices, hospital-based physicians and physicians under age 46 years had higher odds of having an EHR at their main practice location. Physicians who reported more than 30% of their patients were uninsured or enrolled in Medicaid or SCHIP had lower odds of having an EHR. Findings for odds of having an EHR that can meet CMS's meaningful use objectives were similar.

Discussion/Conclusion: Medicaid and Medicare incentive payments may help to reduce gaps in EHR availability by providing small practices and practices that serve high percentages of uninsured, Medicaid, and SCHIP patients with resources for investment in EHRs. CMS should consider targeting outreach regarding incentive payments to physicians in these types of practices.

Learning Areas:
Administration, management, leadership
Program planning

Learning Objectives:
Describe the methods used to conduct a survey regarding California physicians’ experience with electronic health records (EHRs). Identify factors associated with the odds that California physicians will have any EHR at their main practice location and an EHR that can meet the Centers for Medicare and Medicaid Services’ (CMS) objectives for meaningful use of EHRs. Discuss the implications of the study’s findings for the Medicare and Medicaid incentive programs for meaningful use of EHRs.

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been the research associate on the grant for examining the use of electronic health records in California physicians. Among my scientific interests has been the study of physician practices in California.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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