Adoption of electronic health records and preparations for demonstrating meaningful use: an American Academy of Ophthalmology survey

Abstract

Objective: To assess the current state of electronic health record (EHR) use by ophthalmologists, including adoption rate, user satisfaction, functionality, benefits, barriers, and knowledge of meaningful use criteria.

Design: Population-based, cross-sectional study.

Participants: A total of 492 members of the American Academy of Ophthalmology (AAO).

Methods: A random sample of 1500 AAO members were selected on the basis of their practice location and solicited to participate in a study of EHR use, practice management, and image management system use. Participants completed the survey via the Internet, phone, or fax. The survey included questions about the adoption of EHRs, available functionality, benefits, barriers, satisfaction, and understanding of meaningful use criteria and health information technology concepts.

Main outcome measures: Current adoption rate of EHRs, user satisfaction, benefits and barriers, and availability of EHR functionality.

Results: Overall, 32% of the practices surveyed had already implemented an EHR, 15% had implemented an EHR for some of their physicians or were in the process of implementation, and another 31% had plans to do so within 2 years. Among those with an EHR in their practice, 49% were satisfied or extremely satisfied with their system, 42% reported increased or stable overall productivity, 19% reported decreased or stable overall costs, and 55% would recommend an EHR to a fellow ophthalmologist. For those with an electronic image management system, only 15% had all devices integrated, 33% had images directly uploaded into their system, and 12% had electronic association of patient demographics with the image.

Conclusions: The adoption of EHRs by ophthalmology practices more than doubled from 2007 to 2011. The satisfaction of ophthalmologists with their EHR and their perception of beneficial effects on productivity and costs were all lower in 2011 than in 2007. Knowledge about meaningful use is high, but the percentage of physicians actually receiving incentive payments is relatively low. Given the importance of imaging in ophthalmology, the shortcomings in current image management systems need to be addressed.

Financial disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Figure 1.

Relative use of paper and computerized systems for various office functions for all survey respondents (N=492).

Figure 2.

Satisfaction, from extremely unsatisfied to extremely satisfied, of respondents with their computerized clinical systems. EHR = electronic health record.

Figure 3.

Perceived and realized benefits of electronic health records (EHRs) based on responses from practices without and with an EHR. The benefits are sorted on the basis of their relative impact in the group with an EHR. *Statistically significant (P<0.05) difference between respondents with and without an EHR.

Figure 4.

Perceived and realized barriers to the adoption of electronic health records (EHRs). Respondents were asked to report their perception (if they did not have an EHR) or their experience (if they did) of the effect of EHRs on each category. In each case, they could report an EHR was a significant barrier, somewhat of a barrier, or not a barrier, or that they were unsure. The barriers are sorted on the basis of their significance in the group with an EHR. *Statistically significant (P<0.05) difference between respondents with and without an EHR.

Figure 5.

Availability of functions required for meaningful use in respondents’ current electronic health record.

Figure 6.

The relative degree to which subjects are familiar with terminology and concepts important to electronic health records (EHRs) and clinical information technology (IT): Digital Imaging and Communications in Medicine (DICOM), Integrating the Healthcare Enterprise (IHE), Systematized Nomenclature of Medicine (SNOMED), Health Level 7 (HL7), and Picture Archiving and Communication System (PACS).