- Nearly 90% of practices with six or fewer practitioners aren't using advanced EHR features such as electronic messaging, clinical decision support, interoperability, data sharing and patient engagement, according to a recent Black Book survey of about 19,000 EHR users.
- The majority of larger practices use advanced features frequently, and 30% of practices with 11 or more clinicians said they expect to replace their current EHR system by 2021.
- Although larger practices are better positioned to implement new IT tools, 93% of all practices with functioning EHR systems are using basic features that are directly tied to customer satisfaction.
Although the results of the survey aren't surprising, the data shed light on a real problem for small and solo practices: The smaller the practice, the greater the struggle with EHRs. Larger practices, on the other hand, have the resources to purchase new products and features, more time to train doctors and more in-house personnel to handle EHR problems.
While 93% of all practices are using basic EHR features like data repository, order entry and results review, the majority of smaller practices aren't using advanced EHR tools such as patient engagement, secure messaging, decision support and electronic data sharing.
"So when we look at apples-to-apples client satisfaction among small practices, it's about basic functionality experience," Black Book managing partner Dough Brown said in a statement accompanying the report. "While in large practices, the rating of customer satisfaction is based on that plus a much wider breadth of vendor offerings and client execution from claims management to population health bundled in."
The digital divide within the industry has also persisted within hospitals, hampering performance measurement and ultimately improvement. A 2017 JAMA study found that while nearly 81% of hospitals have adopted a basic EHR system, only 38% of hospitals have adopted at least eight of 10 EHR data for performance measurement functions and 42% adopted at least eight patient engagement functions.
Specialists, however, have higher adoption rates than general/family practices. A CDC National Electronic Health Records Adoption Survey published last year found that office-based cardiologists (95.6%), neurologists (94.5%) and urologists (94%) have the highest adoption rates.
A previous Black Book survey found that cloud-hosted EHR options have a record of improving EHR satisfaction, but about 80% of small practices cite pricing as the main factor in selecting a cloud EHR. Brown warned that smaller and solo physician practices are at risk of losing the business of younger generations with higher health IT expectations.