Features of Electronic Medical Records Used in Ambulatory Care Settings in 2005

Features of electronic medical records used in ambulatory care settings in 2005 by Esther Hing, M.P.H., and Catharine W. Burt, Ed.D. Division of Health Care Statistics U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention National Center for Health Statistics Objectives •Examine progress in EMR adoption among ambulatory care settings since 2001 •Hospital emergency departments •Hospital outpatient department •Physician offices •Examine features of electronic medical record (EMR) systems in use in each setting in 2005 •Examine which providers used functional EMRs in 2005 Benchmark use of health information technology Question on electronic medical records use (2005): Does your practice [ED,OPD] use electronic medical records? •Yes, all electronic •Yes, part paper, part electronic •No •Don’t know Features of electronic medical records (EMR) examined in 2005: Does your practice [ED,OPD]’s electronic medical records include•Patient demographic information •Computerized orders for prescriptions •Computerized orders for tests •Test results •Nurse notes •Physician notes •Guideline-based intervention and/or screening test reminders •Public health reporting Other attributes examined: •Number of features included in EMR •For physicians: •Electronic consultations with patients •Claims submitted electronically (electronic billing) Survey Methods •Annual nationally-representative surveys •3,000 office-based physicians •500 hospitals •Scope •Nonfederal office-based physicians excluding radiologists, anesthesiologists, and pathologists •Nonfederal, general and short-stay hospitals with emergency departments (EDs) or outpatient departments (OPDs) Survey Methods (cont.) •Face-to-face induction interview followed by medical record abstraction: ~30 office visits, ~100 ED visits, ~150 OPD visits •Response rates for data presented •NAMCS ~66% •NHAMCS: EDs ~91%, OPDs ~85% •NAMCS estimates based on 1,281 physicians responses. NHAMCS estimates based on responses from 341 hospitals with EDs and 190 hospitals with OPDs Is health information technology being adopted? Computerized administrative and clinical support systems used by office-based physicians 90 80 Electronic billing Percent of physicians 70 60 50 40 30 Electronic medical records 20 Computerized prescription order entry 10 Internet or email patient consultations 0 2001 2002 2003 2004 2005 NOTES: Trends in use of electronic medical records and computerized prescription order entry were statistically significant (p<0.05). Includes nonfederal, office-based physicians who see patients in an office setting. Excludes radiologists, anesthesiologists, and pathologists SOURCE: National Ambulatory Medical Care Survey. Percentage of providers using full or partial electronic medical records (EMR) in 2005 Full 50 45 40 35 30 25 20 15 10 5 0 Partial 43.7 33.5 23.9 Percent of providers 13.5 5.6 11.2 Hospital emergency department Hospital outpatient department Office-based physicians SOURCE: National Hospital Ambulatory Medical Care Survey and National Ambulatory Medical Care Survey. Use of electronic medical records among office-based physicians, hospital outpatient and emergency departments 50 45 40 Hospital emergency departments Percent of physicians 35 30 25 20 15 10 5 0 2001 2002 2003 2004 2005 --President Bush launches Health Information Technology initiative Hospital outpatient departments Office-based physicians NOTES: Office-based physician and hospital emergency department trends are significant (p<.05). Office-based physicians include nonfederal, office-based physicians who see patients in an office setting. Excludes radiologists, anesthesiologists, and pathologists. Sources: National Ambulatory Medical Care Survey and National Hospital Ambulatory Care Survey , 2001-2005 Percentage of providers by electronic medical record features : United States, 2005 50 45 40 35 ED OPD Percent 30 25 20 15 10 5 0 re su lt s og ra p en tr yin de rs he al th Pu bl ic To ta l te st s hi cs no te s no te s Rx rd er Cl in ic O - en tr y 50 45 40 35 O rd er Office-based physicians Percent 30 25 20 15 10 5 0 Ph ys ic ia De m al re m Nu rs e Te st n re su l og ra p en tr y N ur se en tr y re m n in de rs Pu b Ph ys ic ia es t em T rd er rd er O SOURCES: 2005 National Ambulatory Care Medical Care Survey and National Hospital Ambulatory Care Medical Care Survey. C lin ic D O al lic he al th ot al -t es ts hi cs no te s no te s T - Rx ts Percent of providers by number of features included in electronic medical record systems by setting Emergency department Outpatient department Physician offices 20 18 16 14 12 10 8 6 4 2 0 19.0 14.3 13.0 10.7 6.2 11.7 10.0 5.9 10.4 Percent of providers 1-3 features 4-5 features 6-8 features SOURCE: 2005 National Hospital Ambulatory Medical Care Survey and National Ambulatory Medical Care Survey. Eight core functionalities of an electronic medical record system, as defined by Institute of Medicine Health information and data Results management Order management Decision support Electronic communication and connectivity Patient support Administrative processes Reporting Minimum functionalities of electronic medical record system as defined by NAMCS/NHAMCS data items Physician notes Lab results Computerized prescription order entry Computerized test order entry Percentage of providers using minimally functional electronic medical record systems 16 14.6 12.3 9.3 Percent of providers 14 12 10 8 6 4 2 0 Hospital emergency department Hospital outpatient department Office-based physicians NOTE: Minimal EMR functions included lab results, computerized test order entry, physician notes, and computerized prescription order entry. SOURCE: 2005 National Hospital Ambulatory Medical Care Survey and National Ambulatory Medical Care Survey. Percentage of providers with medical record features, by whether EMR is minimally functional : United States, 2005 50 45 40 35 Hospital emergency departments Percent 30 25 20 15 10 5 0 Hospital outpatient departments en tr in yic Rx al re m in de Pu rs bl ic he al th re su lts -t es ts no te s ph ic s no te s 50 45 40 35 To ta l og ra n en tr y Te st Or de r Or de r De m Ph ys i Nu rs ci a e Percent Cl 30 25 20 15 10 5 0 Minimally functional EMR 50 45 40 35 Any functions Office-based physicians To ta l Percent en tr y Te st ic ia 30 25 20 15 10 5 0 De m og r Or de r Or de r Ph ys To ta l no te s -t es ts no te s ic s lts x De m og r Or de r Ph ys Or de r SOURCES: 2005 National Ambulatory Care Medical Care Survey and National Hospital Ambulatory Care Medical Care Survey. Cl in ic re m in de rs Pu bl ic he al th re su ap h en tr y n e en tr y Te st Nu rs ic ia -R al Cl in ic x re m in de rs Nu rs e no te s Pu bl ic he al th al -t es ts lts no te s n ic s re su ap h en tr y -R Which providers used minimally functional electronic medical record systems in 2005? Results that follow are based on univariate and logistic regressions of use within each ambulatory care setting Percent of providers using comprehensive EMR by size and setting 25 Hospital emergency departments Percent of providers 20 15 10 5 0 Under 100 beds 100-199 beds/1 200 or more beds/1 Percent of providers Hospital outpatient departments 25 20 15 10 5 0 Under 100 beds 100-199 beds 200 or more beds/1 25 Office-based physicians Percent of providers 20 15 10 5 0 Solo Partner 3-5 physicians 6-10 physicians/2 11 or more physicians/2 1/ Adjusted odds of use higher relative to reference group (Under 100 beds). 2/ Adjusted odds of use higher relative to reference group (Solo). SOURCE: 2005 National Hospital Ambulatory Medical Care Survey and National Ambulatory Medical Care Survey. Percent of providers using comprehensive EMR by geographic region and setting Emergency department Outpatient department Physician offices 50 45 40 35 30 25 20 15 10 5 0 Northeast/1,2 West South West/1 1/ Adjusted odds of use by hospital outpatient departments significantly higher relative to reference group (South). 2/ Adjusted odds of use for physicians significantly lower relative to reference group (South). SOURCE: 2005 National Hospital Ambulatory Medical Care Survey and National Ambulatory Medical Care Survey. Percent of providers Percent of office-based physicians using comprehensive EMR by practice ownership 60 Percent of providers 50 40 30 20 10 0 Physician or group practice 7.3 49.6 13.2 HMO/1 Other 1/ HMO is health maintenance organization. Adjusted odds of use higher than reference group (physician or group practice). SOURCE: 2005 National Ambulatory Medical Care Survey. Conclusions  Use of any type of electronic medical record increased between 2001 and 2005 – by 46% hospital emergency departments – by 31% office-based physicians  New data suggest more hospital EDs and OPDs are in the process of implementing EMRs (part electronic, part paper)  30.2 percent of EDs  27.9 percent of OPDs  12.7 percent of office-based physicians Conclusions In 2005, however, only 9-15 percent of ambulatory care providers, however, used minimally functional EMR systems Adjusted odds of use of comprehensive EMRs by hospital EDs and OPDs and by physicians had significant effect by size of the organization. Conclusions Adjusted odds of comprehensive EMR use by hospital OPDs and physicians varied by geographic region. OPDs in the Northeast and West had higher use and physicians in the Northeast had lower use, after adjusting for all other variables. Limitations Some hospital size estimates had large standard errors due to small cell sizes, particularly among hospital OPDs. Some differences may reflect variation in use rather than feature availability during EMR implementation – Physicians and hospital staff reporting may vary as familiarity with the EMR increases Further analysis is planned using combined 2005-06 NHAMCS data when available. Policy implications EMR systems varied among ambulatory care providers. Certification of EMR systems by the Office of National Coordinator for Health Information Technology starting in 2006 may lead to marketing of more standardized EMR systems. Policy implications Lower EMR use among smaller physician practices and among EDs and OPDs in smaller hospitals is consistent with findings from previous studies. Ongoing initiatives to promote EMR adoption need to address these and other barriers before EMR adoption is more widely accepted by ambulatory care providers.