Physician EHR Experience with Meaningful Use Criteria: NAMCS 2011

This report, based on the National Ambulatory Medical Care Survey (NAMCS) Physician Workflow Survey 2011, examines physician experiences with Electronic Health Record (EHR) systems, comparing clinical and financial indicators between those with and without systems meeting meaningful use criteria. The findings indicate that approximately three-quarters of physicians with EHR systems have systems meeting federal Stage 1 Meaningful Use Criteria, and these physicians reported time-saving efficiencies like faster lab results and electronic prescribing compared to those with systems not meeting the criteria. Furthermore, physicians using EHR systems meeting meaningful use criteria were less likely to perceive disruptions in patient interactions and more likely to agree on enhanced data confidentiality. While most physicians perceived clinical and financial benefits regardless of whether their system met meaningful use criteria, common challenges included increased time spent documenting care and potential disruption of patient interactions. The study highlights the impact of the HITECH Act of 2009 on EHR adoption and use in physician practices.

NCHS Data Brief ■ No. 129 ■ September 2013
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Disease Control and Prevention
National Center for Health Statistics
Key findings
Data from the National
Ambulatory Medical
Care Survey’s (NAMCS)
Physician Workflow
Survey, 2011
• About three-quarters of
physicians with electronic health
record (EHR) systems have
systems that meet meaningful use
criteria.
• Physicians with EHR systems
that meet meaningful use criteria
were more likely to report that
their system provides time savings
than physicians with systems not
meeting meaningful use criteria,
but only in some areas.
• Physicians with EHR systems
that meet meaningful use criteria
were more likely to report
enhanced confidentiality and less
disruption in their interactions
with patients than physicians with
systems not meeting meaningful
use criteria.
• Physicians with EHR systems
that meet meaningful use criteria
were no more likely to report
financial benefits and selected
clinical benefits than those with
systems not meeting meaningful
use criteria.
Physician Experience With Electronic Health Record Systems
That Meet Meaningful Use Criteria: NAMCS Physician
Workflow Survey, 2011
Eric Jamoom, Ph.D., M.P.H., M.S.; Vaishali Patel, M.P.H., Ph.D.; Jennifer King, Ph.D.; and
Michael F. Furukawa, Ph.D.
The Health Information Technology for Economic and Clinical Health
(HITECH) Act of 2009 provides financial incentives for physicians who
adopt and demonstrate the “meaningful use” of a certified electronic health
record (EHR) system (1,2). EHR systems that meet the meaningful use criteria
have specific capabilities associated with efficient and high-quality patient
care (3). Since enactment of the HITECH Act, nationally representative data
about physician experiences with EHRs have been limited (4,5). This report
describes physician experiences with EHRs, comparing clinical and financial
indicators between physicians with and without EHR systems that meet
meaningful use criteria.
Keywords: health information technology • National Ambulatory Medical
Care Survey
How common are EHR systems that meet meaningful use
criteria in physician practices?
• About three-quarters of EHR adopters (76%) report that they have a
system that meets the Centers for Medicare & Medicaid Services (CMS)
Figure 1. Percentage of physicians with electronic health record systems that meet meaningful
use criteria: United States, 2011
NOTES: Data represent office-based physicians with electronic health record systems (n = 1,793). Missing responses (less than
2%) were excluded. Meaningful use criteria were approved by the federal Centers for Medicare & Medicaid Services. The sample
includes nonfederal, office-based physicians and excludes anesthesiologists, radiologists, and pathologists. Percentages may not
sum to 100 because of rounding.
SOURCE: CDC/NCHS, National Ambulatory Medical Care Survey's Physician Workflow Survey, 2011.
Does not meet
8
Uncertain
15 Meets
76

NCHS Data Brief ■ No. 129 ■ September 2013
■ 2 ■
meaningful use criteria, whereas 8% have a system that does not meet the meaningful use
criteria. About 15% of respondents are uncertain whether their system meets the meaningful
use criteria (Figure 1).
Are physicians who have EHR systems that meet meaningful use criteria
more likely to report time savings?
Figure 2. Percentage of physicians using electronic health record systems who report agreement with selected efficiency
indicators, by whether the systems meet meaningful use criteria: United States, 2011
1Differences between physicians with systems that meet meaningful use criteria and those with systems not meeting these criteria were significant (p < 0.05).
NOTES: EHR is electronic health record. Data represent office-based physicians with EHR systems (n = 1,793). Missing responses (less than 6%) were excluded
for each of the items.
SOURCE: CDC/NCHS, National Ambulatory Medical Care Survey's Physician Workflow Survey, 2011.
Percent
EHR does not
meet meaningful
use criteria or
uncertain
EHR meets
meaningful use
criteria
0 20 40 60 80 100
Amount of time spent responding
to pharmacy calls increased
My practice receives
laboratory results faster
Amount of time spent to plan,
review, order, and document
care has increased
Sending prescriptions
electronically saves me time
182
67
76
78
175
61
28
34
• Eighty-two percent of physicians with an EHR system that meets meaningful use criteria
agree that electronic prescribing saves them time, compared with 67% of physicians whose
EHR system did not meet meaningful use criteria (Figure 2).
• Seventy-five percent of physicians with an EHR system that meets meaningful use criteria
agree that their practice receives laboratory results faster, compared with 61% of physicians
whose EHR system did not meet meaningful use criteria (Figure 2).
• Approximately one-third of physicians with an EHR system judged that it increases the
time taken to answer pharmacy calls, regardless of whether the system met meaningful use
criteria (Figure 2).
• Regardless of whether their EHR system met meaningful use criteria, over three-quarters of
these physicians reported that the amount of time taken to plan, review, order, and document
care has increased due to using the system (Figure 2).

NCHS Data Brief ■ No. 129 ■ September 2013
■ 3 ■
Are physicians who have EHR systems that meet meaningful use criteria
more likely to report clinical and financial benefits?
Figure 3. Percentage of physicians using electronic health record systems who report agreement with selected clinical and
financial benefits indicators, by whether the system meets meaningful use criteria: United States, 2011
1Differences between physicians with systems that meet meaningful use criteria and those with systems not meeting these criteria were significant (p < 0.05).
NOTES: EHR is electronic health record. Data represent office-based physicians with EHR systems (n = 1,793). Missing responses (less than 6%) were excluded
for each of the items.
SOURCE: CDC/NCHS, National Ambulatory Medical Care Survey's Physician Workflow Survey, 2011.
Percent of EHR adopters
0 20 40 60 80 100
EHR does not
meet meaningful
use criteria or
uncertain
EHR meets
meaningful use
criteria
Billing for services is less complete
My EHR disrupts the way
I interact with my patients
My EHR enhances data confidentiality
My EHR allows me to deliver
better patient care
My EHR makes records more readily
available at the point of care
My practice saves on costs
associated with managing and
storing paper records
Financial benefits
Clinical benefits
94
91
75
69
170
60
150
61
75
72
22
18
• Sixty-one percent of physicians with an EHR system not meeting meaningful use criteria
believed that it disrupts the way they interact with patients, compared with 50% of
physicians with an EHR system that meets meaningful use criteria (Figure 3).
• Seventy percent of physicians with an EHR system that meets meaningful use criteria
agreed that their system enhances patient data confidentiality, compared with 60% of
physicians whose EHR system did not meet the criteria (Figure 3).
• Physicians with an EHR system largely agreed that the system makes records more readily
available at the point of care (94% meeting meaningful use, 91% not meeting meaningful
use), and allows them to deliver better patient care (75% meeting meaningful use, 69% not
meeting meaningful use), regardless of whether the system met the CMS criteria (Figure 3).
• Almost three-quarters of physicians with an EHR system (75% meeting meaningful use,
72% not meeting meaningful use) judged that it saves on costs associated with managing
and storing paper records, regardless of whether the system met meaningful use criteria
(Figure 3).

NCHS Data Brief ■ No. 129 ■ September 2013
■ 4 ■
Summary
Based on nationally representative data, about three-quarters of physicians with an EHR system
have a system that meets federal Stage 1 Meaningful Use Criteria.
Physicians with EHR systems meeting these criteria believed that the systems provide some time-
saving practice efficiencies, such as receiving laboratory results faster and enabling electronic
prescribing, compared with systems not meeting meaningful use criteria. In addition, physicians
using an EHR system that meets meaningful use criteria were less likely to perceive their
system as disrupting the way they interact with patients than those using a system not meeting
the criteria. Moreover, physicians with an EHR system that meets meaningful use criteria were
more likely to agree that the system enhanced data confidentiality, compared with those having a
system not meeting the criteria.
A majority of physicians judged their EHR system to have various clinical effects, financial
benefits, and some efficiencies, regardless of whether their system met the meaningful use
criteria. Clinical benefits perceived among EHR system users included the availability of
records at the point of care, and the ability to deliver better patient care due to using the system.
However, at least one-half of physicians with an EHR system believed that it disrupts the way
they interact with patients. A majority of physicians considered their EHR system as providing
specific financial benefits, such as allowing them to save on costs associated with managing and
storing paper records, and resulting in at least the same or more complete billing. Amajority of
physicians with EHR systems also believed that their system provided practice efficiencies, such
as receiving laboratory results faster, saving time with electronic prescribing, and spending at
least the same or less time responding to pharmacy calls. However, most physicians with an EHR
system experienced an increase in time spent planning, reviewing, ordering, and documenting
care. A majority of physicians with EHR systems judged them as enhancing data confidentiality.
These survey findings provide insight into the effects of using EHR systems since the 2009
enactment of HITECH. The findings indicate common challenges of using EHR systems,
including increased time spent documenting care and the disruption of patient interactions. The
findings suggest that most physicians have experienced various clinical and financial benefits, as
well as practice efficiencies, from using EHR systems, with physicians using an EHR system that
meets meaningful use criteria reporting greater specific time-saving benefits.
Definitions
Physician office: A place where physicians who are not federally employed provide direct patient
care, within the 50 states and the District of Columbia; excludes radiologists, anesthesiologists,
and pathologists.
System meets/does not meet meaningful use criteria: Meaningful use in this report was
determined based on whether a respondent’s EHR was certified to meet the U.S. Department of
Health and Human Services’ Stage 1 Meaningful Use Criteria. This variable was created based
on responses to the question, “Does your current system meet Meaningful Use criteria, as defined
by the Centers for Medicare & Medicaid Services (CMS)?” Response categories were “yes,”
“no,” and “uncertain.” Physicians who answered yes were considered to use an EHR system that
meets meaningful use criteria. To qualify for the CMS incentive payments for meaningful use, an

NCHS Data Brief ■ No. 129 ■ September 2013
■ 5 ■
eligible provider must use a certified EHR system demonstrating all 15 of the core set objectives
and 5 of 10 menu set objectives through associated measures or by attestation in 2011 (2). A
system not meeting these criteria was defined as physicians answering “no” or “uncertain,” or a
missing response (less than 2%).
EHR adopters: Derived from office-based physicians who answered the National Ambulatory
Medical Care Survey (NAMCS) Electronic Medical Records mail survey question, “Does the
reporting location use an electronic medical record (EMR) or electronic health record (EHR)
system? Do not include billing record systems.” Adopters are those who answered either “yes, all
electronic” or “yes, part paper and part electronic,” whereas nonadopters answered “no” to using
EMR or EHR systems.
Benefits of an EHR: Physician perceptions were calculated from their responses to questions
that asked whether they agree with statements about using EHRs. Response categories were:
“strongly agree,” “somewhat agree,” “somewhat disagree,” and “strongly disagree” (6,7). Both
sets of agreement and disagreement responses were combined, creating dichotomous variables of
agree and disagree. Missing responses represented 1%–6% of physicians. Item nonresponse may
indicate that a specific benefit was not applicable to the physician’s scope of work or role in the
practice.
Data source and methods
The data for this report come from the NAMCS Physician Workflow Survey and include
physicians who have adopted an EHR system. The Physician Workflow Survey, funded by the
Office of the National Coordinator for Health Information Technology, is conducted by the
Centers for Disease Control and Prevention’s National Center for Health Statistics (NCHS). It
represents a 3-year initiative to survey office-based physicians about their experiences with and
perceptions of adopting and using an EHR system. Respondents are followed annually over a
3-year period, from 2011 through 2013. More detailed information about the study design is
provided in an earlier report (4).
The sample consisted of those physicians confirmed eligible (i.e., seeing ambulatory patients in a
physician’s office) and answering the question about EHR use (see Definitions–EHR adopters) in
the earlier 2011 NAMCS EMR mail survey (8). Eligible physicians for whom adoption status was
not confirmed in the EMR survey were contacted to determine that status. Only eligible NAMCS
respondents were mailed a Physician Workflow Survey questionnaire within a 2-month period
of determining whether they used a system. Adopters received a different questionnaire from
nonadopters (6,7). For this report, nationally weighted estimates are presented for 1,793 EHR
adopters from the 2011 physician workflow mail survey.
All comparisons reported in the text are statistically significant unless otherwise indicated.
Comparisons not mentioned may or may not be statistically significant. Data analyses were
performed using the statistical packages SAS version 9.2 (SAS Institute, Cary, N.C.) and
SUDAAN version 10.0 (RTI International, Research Triangle Park, N.C.)

NCHS Data Brief ■ No. 129 ■ September 2013
■ 6 ■
About the authors
Eric Jamoom is with the Centers for Disease Control and Prevention’s National Center for Health
Statistics, Division of Health Care Statistics. Vaishali Patel, Jennifer King, and Michael Furukawa
are with the U.S. Department of Health and Human Services’ Office of the National Coordinator
for Health Information Technology, Office of Economic Analysis, Evaluation, and Modeling.
References
1. Blumenthal D, Tavenner M. The “meaningful use” regulation for electronic health records.
N Engl J Med 363(6):501–4. 2010.
2. Centers for Medicare & Medicaid Services. The official Web site for the Medicare &
Medicaid EHR incentive programs. Available from: https://www.cms.gov/ehrincentiveprograms/
[Accessed August 1, 2013].
3. Buntin MB, Jain SH, Blumenthal D. Health information technology: Laying the infrastructure
for national health reform. Health Aff (Millwood) 29(6):1214–9. 2010.
4. Jamoom E, Beatty P, Bercovitz A, et al. Physician adoption of electronic health record
systems: United States, 2011. NCHS data brief, no 98. Hyattsville, MD: National Center for
Health Statistics. 2012.
5. DesRoches CM, Campbell EG, Rao SR, Donelan K, Ferris TG, Jha A, et al. Electronic health
records in ambulatory care—A national survey of physicians. N Engl J Med 359(1):50–60. 2008.
6. National Center for Health Statistics. Physician workflow supplement 2011 [EHR adopters],
National Ambulatory Medical Care Survey. 2011. Available from: http://www.cdc.gov/nchs/
data/ahcd/2011_Physician_Workflow_Supplement_for_EHR_Adopters.pdf [Accessed August 1,
2013].
7. National Center for Health Statistics. Physician workflow supplement 2011 [EHR
nonadopters], National Ambulatory Medical Care Survey. 2011. Available from: http://www.
cdc.gov/nchs/data/ahcd/2011_Physician_Workflow_Supplement_for_EHR_Non-Adopters.pdf
[Accessed August 1, 2013].
8. National Center for Health Statistics. Electronic medical records supplement 2011, National
Ambulatory Medical Care Survey. 2011. Available from: http://www.cdc.gov/nchs/data/
ahcd/2011_EMR_Survey.pdf [Accessed August 1, 2013].

NCHS Data Brief ■ No. 129 ■ September 2013
■ 7 ■

NCHS Data Brief ■ No. 129 ■ September 2013
U.S. DEPARTMENT OF
HEALTH & HUMAN SERVICES
Centers for Disease Control and Prevention
National Center for Health Statistics
3311 Toledo Road, Room 5419
Hyattsville, MD 20782
OFFICIAL BUSINESS
PENALTY FOR PRIVATE USE, $300
FIRST CLASS MAIL
POSTAGE & FEES PAID
CDC/NCHS
PERMIT NO. G-284
Suggested citation
Jamoom E, Patel V, King J, Furukawa MF.
Physician experience with electronic health
record systems that meet meaningful use
criteria: NAMCS Physician Workflow
Survey, 2011. NCHS data brief, no 129.
Hyattsville, MD: National Center for Health
Statistics. 2013.
Copyright information
All material appearing in this report is in
the public domain and may be reproduced
or copied without permission; citation as to
source, however, is appreciated.
National Center for Health
Statistics
Charles J. Rothwell, M.S., Acting Director
Jennifer H. Madans, Ph.D., Associate
Director for Science
Division of Health Care Statistics
Clarice Brown, M.S., Director
For e-mail updates on NCHS publication
releases, subscribe online at:
http://www.cdc.gov/nchs/govdelivery.htm.
For questions or general information
about NCHS:
Tel: 1–800–CDC–INFO (1–800–232–4636)
TTY: 1–888–232–6348
Internet: http://www.cdc.gov/nchs
Online request form: http://www.cdc.gov/
cdc-info/requestform.html
ISSN 1941–4927 Print ed.
ISSN 1941–4935 Online ed.
DHHS Publication No. 2013–1209
CS 243145