DEP-\RTi\lE1\T OF H tALTH A...ND HlTlVLAl'\T SERVICES' 
()FFICE <)F INSPECT{)R GENE.RAL 
JUN 21 20ll 
TO:  Farzad Mostashari, M.D., Sc.M. 
National Coordinator for Health Information Technology 
Office of the National Coordinator 
for Health Information Technology 
Marilyn Tavenner 
Acting Administrator 
Centers for Medicare & Medicaid Services 
FROM:  Stuart Wright 
Deputy Inspector General 
for Evaluation and Inspections 
SUBJECT:  Memorandum Report:  Use ofElectronic Health Record Systems in 2011 
Among Medicare Physicians Providing Evaluation and Management Services, 
OEI -04-10-00184 
This memorandum report responds to a request from officials of the Office of the 
National Coordinator for Health Information Technology (ONC), who expressed interest 
in information about physicians' reported use of electronic health record (EHR) systems. 
ONC officials made this request in connection with an ongoing evaluation on the extent 
ofdocumentation vulnerabilities of evaluation and management (ElM) services using 
EHR systems (OEI-04-10-00182), which will be issued separately.  ONC officials also 
wanted to know how many and which EHR systems were being used and whether the 
Medicare physicians in our study were using certified EHR systems to document ElM 
services.  We are also sending this report to the Centers for Medicare & Medicaid 
Services (CMS), which may find this information helpful as it continues administering its 
EHR incentive program. 
SUMMARY 
We found that 57 percent ofMedicare physicians used an EHR system at their primary 
practice location in 2011.  Overall, 95 percent ofphysicians who used an EHR system to 
document EIl\1 services first began using it between 2001 and 2011.  Ofthese physicians, 
the largest percentage (22 percent) began using EHR systems in 2011, the year that eMS 
commenced its incentive program.  Additionally, three of every four Medicare physicians 
with an EHR system used a certified system to document ElM services.  Finally, although  Page 2  Farzad Mostashari, M.D., Sc.M.; Marilyn Tavenner  
 
  
many EHR systems can assist physicians in assigning codes for E/M services, we found 
that most Medicare physicians manually assigned E/M codes. 
 
BACKGROUND 
  
Meaningful Use of Certified EHR Technology 
The HITECH Act of 2009 established the goal of achieving meaningful use of EHR 
technology in Medicare.1,  2  Meaningful use means that Medicare physicians use certified 
EHR technology in ways (e.g., electronic prescribing) that can be measured to improve 
the quality of health care for patients and adhere to the standards and criteria of the EHR 
incentive program.3, 4  Starting in 2015, physicians will be subject to Medicare payment 
reductions if they do not demonstrate meaningful use of certified EHR systems.5    
 
An EHR system is a computerized recordkeeping approach that allows physicians to 
record patient information electronically instead of using paper records.6  ONC is 
responsible for coordinating nationwide efforts to use health information technology, 
such as certified EHR systems, and for the electronic exchange of health information.7    
 
ONC has promulgated regulations pertaining to the initial set of standards and 
certification criteria and to the temporary and permanent certification programs.8  For 
instance, ONCs rules contain security provisions, such as requiring that an EHR system  
be capable of maintaining audit logs, have automatic logoff, have access control, and 
permit emergency access.9  Additionally, ONC has coordinated with CMS to promulgate  
   
                                                 
1 
Title XIII of the American Recovery and Reinvestment Act of 2009, P.L. 111-5.  See also, Department of 

Health and Human Services (HHS) News Release, Accelerating Electronic Health Records Adoption and 

Meaningful Use, August 2010.

2 
EHR technology includes both certified EHR systems and add-on modules. 
 
3  Social Security Act (SSA)  1848(o)(2).  CMS issued regulation that defines meaningful use for its EHR 

incentive program.  CMS, EHR Incentive Program Regulations and Notices, May  2012. 

4 
To participate in the EHR incentive program, Medicare physicians must attest that their certified EHR system is 

secure, can maintain data confidentiality, can work with other EHR systems to share information, and can 

perform a set of well-defined functions.  ONC, Standards &  Certification Criteria Final Rule, March 2011.   

5  SSA  1848(a)(7). Regardless of whether physicians participate in the Medicare EHR incentive program, they
  
will be subject to Medicare payment reductions beginning in 2015 if they do not demonstrate meaningful use of 

certified EHR systems.  See also CMS, Medicare and Medicaid EHR Incentive Program Basics, October 2011.   

6 
EHRs can include information about patient demographics, progress notes, medications, medical history, and 

clinical test results from any health care encounter.  CMS, Electronic Health Records Overview, October 2011.   

7 
Public Health Service Act  3001, as enacted in the HITECH Act.  See also ONC, About ONC, October 2011.  

Accessed at http://healthit.hhs.gov/portal/server.pt/community/healthit_hhs_gov__onc/1200 on February 7,  2012. 

8 
See ONCs initial set of standards and certification criteria at 75 Fed. Reg. 44590 (July 28, 2010).  ONC 

promulgated the rules for its Temporary Certification Program and its Permanent Certification Program at, 

respectively, 75 Fed. Reg. 36158 (June 24, 2010) and 76 Fed. Reg. 1262 (Jan. 7, 2011). 

9
 45 CFR  170.302(o)-(r). 

Use of EHR Systems in 2011 Among Medicare Physicians  Providing E/M Services   OEI-04-10-00184         Page 3  Farzad Mostashari, M.D., Sc.M.; Marilyn Tavenner 
 
 
the meaningful use criteria for the first stage of the EHR incentive program.10      
 
Physicians must demonstrate the meaningful use of certified EHR systems to avoid 
payment reductions beginning in 2015.11  EHR systems are certified by an Authorized 
Testing and Certification Body (ONC-ACTB) according to certification processes 
defined by ONC.12, 13  As of March 2012, approximately 1,200 EHR products were 
certified by ONC-ACTB. Certification criteria require that EHR systems have the 
necessary technological capability, functionality, and security to meet the applicable 
meaningful use criteria.  These criteria can include the capability to maintain active 
medication allergy lists and provide clinical summaries for patients for each office visit, 
as defined in CMS regulation.14  However, companies (i.e., vendors) that develop and 
market EHR systems can include additional capabilities that are not required for the 
purposes of certification.  
 
In 2011, CMS began a three-stage, 5-year EHR incentive program with objectives that 
physicians must meet to demonstrate their meaningful use of certified EHR technology.15   
Each stage requires increasing use of EHR technology and electronic information 
exchange. For Stage 1, physicians must meet 15 core objectives (e.g., maintain active 
medication list) and 5 of 10 menu objectives (e.g., submit electronic data to immunization 
registries) to receive an EHR incentive payment.16  In March 2012, CMS issued a notice 
of proposed rulemaking to delineate the Stage 2 meaningful use requirements for certified 
EHR technology. Stage 3 meaningful use requirements are expected to be proposed in 
early 2014. 
 
E/M Services 
Physicians and nonphysician practitioners can use EHR systems to document E/M 
services, which are visits to assess and manage a patients health.  Hereinafter, we refer to  
physicians and nonphysician practitioners as physicians.17  In 2010, approximately  
65 percent of all Medicare physicians  billed for E/M services, accounting for 
$33.5 billion of $110 billion (30 percent) in total payments for Medicare Part B goods 
                                                 
10 
See CMSs meaningful use regulations at 75 Fed. Reg. 44314 (July 28, 2010). 

11 
Social Security Act  1848(a)(7). 

12  See 75 Fed. Reg. 36158 (June 24, 2010) and 76 Fed. Reg. 1262 (Jan. 7, 2011).  

13 
ONC selected six organizations as ATCBs.  ONC, ONC-Authorized Testing and Certification Bodies, March 

2012. 
  
14
 45 CFR  170.302, 170.304, and 170.306. 

15 
See 75 Fed. Reg. 44314 (July  28, 2010).  Starting in 2011, physicians can receive up to $44,000 over 5 years 

under the Medicare EHR incentive program.  See 75 Fed. Reg. 44314, 44551 (July 28, 2010). See also CMS, 

EHR Incentive Programs:  Overview, April 2011.
  
16 
42 CFR  495.6. 

17
 Nonphysician practitioners are health care providers (i.e., nurse practitioners, clinical nurse specialists, and 

physician assistants) who practice either in collaboration with or under the supervision of a physician.  

Use of EHR Systems in 2011 Among Medicare Physicians  Providing E/M Services   OEI-04-10-00184         Page 4  Farzad Mostashari, M.D., Sc.M.; Marilyn Tavenner  
 
 
and services.18, 19  E/M services also represented 45 percent of the top 20 procedure codes 
billed to Medicare in 2010.20    
 
E/M services are grouped into visit types.  Each visit type reflects the type of service, the 
place of service, and the patients status.  For example, there are two types of office visits 
(new patient and established patient). Similarly, there are two types of hospital visits 
(initial and subsequent). 
 
Most E/M services are billed using codes that reflect the complexity of the service, 
ranging from lower level (i.e., less complex and less expensive) to higher level (i.e., more 
complex and more expensive) codes.21  Within each visit type, Medicare payment for the 
E/M service depends on the complexity of the visit.   
 
EHR Systems and E/M Coding 
Numerous EHR systems with various capabilities and features are available for purchase 
from vendors.  For example, some EHR systems have add-on modules that automatically 
assign E/M codes based on the information provided by the physician.22  However, ONC 
has not established standards for how physicians should use EHR systems to create 
medical records that meet CMS documentation requirements for E/M services.23,  24     
 
Vendors can market these additional capabilities to physicians as tools to enhance E/M 
coding accuracy and efficiency, as well as to ensure that the highest E/M code is used to 
optimize revenue.25  Depending on the vendor, add-on modules may include broader 
applications of the coding software, such as generating diagnosis and complexity levels 
associated with an E/M code.  Other modules can also provide feedback to describe how 
the code was derived. 
 
   
                                                 
18 
Office of Inspector General (OIG) analysis of 2010 National Claims  History (NCH) File and 2010 Part B 

Analytic Reports (PBAR) National Procedure Summary File. 

19
 Medicare payment refers to total Medicare-allowed amounts, which are 100 percent of the payment made to a 

physician by both Medicare and the beneficiary.  Medicare pays 80 percent of allowed charges and the 

beneficiary is responsible for paying the remaining 20 percent.   

20 
OIG analysis of 2010 PBAR National Procedure Summary File. 

21 
American Medical Association (AMA), Current Procedural Terminology, 2010.     
22 
American Health Information Management Association (AHIMA), Automated Coding Software:  
Development and Use To Enhance Anti-Fraud Activities (HHSP23320054100EC), July 2005.   
23
 Per CMS policy, physicians must use either the 1995 or 1997 Document Guidelines for Evaluation and 
Management Services to document the medical record with the appropriate clinical information to support the 
E/M code billed. CMS, Evaluation and Management Services  Guide 2010, December 2010.    

24 
AMAs comments on ONCs proposed rule, Health Information Technology:  Standards, Implementation 
 
Specifications, and Certification Criteria for Electronic Health Record Technology, 2014 Edition,  May 2012. 

25 
AHIMA, Automated Coding Software:  Development and Use To Enhance Anti-Fraud Activities 
 
(HHSP23320054100EC), July  2005. 

Use of EHR Systems in 2011 Among Medicare Physicians  Providing E/M Services   OEI-04-10-00184         Page 5  Farzad Mostashari, M.D., Sc.M.; Marilyn Tavenner   
 
 
Related Work 
This evaluation is part of a series of studies by OIG on E/M services.  OIG previously 
examined the coding trends of E/M services from 2001 to 2010 and identified physicians 
who consistently billed higher level (i.e., more complex and more expensive) codes in 
2010.26  Subsequent evaluations will determine the appropriateness of Medicare 
payments for E/M services and the extent of documentation vulnerabilities of E/M 
services using EHR systems.    
 
The Centers for Disease Control and Prevention (CDC) provides an annual report that 
describes trends in the use of EHR systems and physicians intentions to apply for EHR 
incentive payments.  This report is based on a survey of office-based physicians who 
provide direct care to patients.27  In 2011, CDC found that 57 percent of office-based 
physicians reported using an EHR system at their practice location.  CDC also found that 
34 percent of these physicians had an EHR system that met some of the meaningful use 
requirements.  Additionally, 52 percent of office-based physicians reported their intention 
to apply for EHR incentive payments in 2011. 
 
METHODOLOGY 
  
Scope 
This memorandum report describes the extent to which Medicare physicians used EHR 
and certified EHR systems to document E/M services through 2011.  Using claims data 
from a companion study on E/M services, we selected a simple random sample of 
2,000 Medicare physicians from a population of 441,990 physicians who provided at 
least 100 E/M services in 2010.28    
 
Data Collection and Analysis  
We conducted an electronic survey on our simple random sample of 2,000 Medicare 
physicians. We received responses from  1,506, for a 75-percent response rate.  We  
conducted our survey between October 2011 and January 2012. 
 
 
 
 
                                                 
26 
OIG, Coding Trends of Medicare Evaluation and Management Services, OEI-04-10-00180, April 2012.
27
 CDC,  Electronic Health Record Systems and Intent to Apply for Meaningful Use Incentives Among Office-
Based Physician Practices:  United States, 20012011, November 2011.  CDC defined office-based physicians 
as nonfederally employed physicians located in the 50 States and the District of Columbia, excluding 
radiologists, anesthesiologists, and pathologists. 
28 
OIG, Coding Trends of Medicare Evaluation and Management Services, OEI-04-10-00180, April 2012. We  
used the National Provider Identifier (NPI) field from the NCH carrier file to determine the number of 
physicians.  We did not verify  whether those NPIs were valid.  Claims  submitted by physicians who provided 
fewer than 100 E/M services represented less than 2 percent of Medicare payments and 30 percent of all 
physicians who provided E/M services.  
Use of EHR Systems in 2011 Among Medicare Physicians  Providing E/M Services   OEI-04-10-00184          
Page 6  Farzad Mostashari, M.D., Sc.M.; Marilyn Tavenner  
 
 
We collected descriptive information about physicians use of EHR systems for 
documenting E/M services.  We asked Medicare physicians whether they currently used 
an EHR system at their primary practice locations.29  We defined use as having an EHR 
system that was purchased, installed, tested, and being utilized at the physicians primary 
practice location.30  If physicians reported using EHR systems, we asked whether they 
used EHR systems to document E/M services.31  
 
We also asked Medicare physicians who currently used EHR systems to document E/M 
services to name the year they first started using this technology.  We also asked these 
physicians how often they used EHR systems to document E/M services and whether 
E/M codes are manually assigned by the physician or staff.  Additionally, we asked 
Medicare physicians which EHR system they used to document E/M services and 
whether their EHR system was certified.  We  then used ONCs list of certified EHR 
technology to determine whether each physicians EHR system was certified by an 
ONC-ACTB. 32  
 
All estimates in this report are projected to the specified population or subpopulation of 
Medicare physicians who provided E/M services in 2010, at the 95-percent confidence 
level. Appendix A shows the sample size, point estimates, and 95-percent confidence 
intervals for all statistics in this report.  
 
Limitations  
This study relies on self-reported data from Medicare physicians.  We did not request 
documentation to verify their responses.   
 
Standards 
This study was  conducted in accordance with the Quality Standards for Inspection and 
Evaluation approved by the Council of the Inspectors General on Integrity and 
Efficiency. 
   
                                                 
29 
We defined an EHR in our survey as an electronic health record of patient health information generated by one 
or more encounters to streamline the workflow in care-delivery organizations. 
30 
We did not consider billing software as an EHR system.  We  excluded responses from 34 Medicare physicians 
because they reported using billing software instead of an EHR system. 
31 
Seventy-five respondents indicated that either they do not use or do not know whether they use an EHR 
system to document E/M services.  We excluded responses from eight Medicare physicians because later in our 
survey, they indicated not using EHR systems to document E/M services.  We also excluded responses from  two 
Medicare physicians because they indicated first using an EHR system to document E/M services in 2012.   
32
 ONC, Certified HIT Product List, December 2010.  Accessed at http://oncchpl.force.com/ehrcert?q=CHPL on  
June 14, 2012. 
Use of EHR Systems in 2011 Among Medicare Physicians  Providing E/M Services   OEI-04-10-00184         Page 7  Farzad Mostashari, M.D., Sc.M.; Marilyn Tavenner  
 
 
RESULTS  
   
Fifty-Seven Percent of Medicare Physicians Used EHR Systems at Their Primary  
Practice Locations in 2011 
Of the physicians who had an EHR system, 90 percent used their systems to document 
E/M services. See Table A-1 in Appendix A for the percentage of physicians who used 
an EHR system. 
 
Overall, 95 percent of physicians who used an EHR system in 2011 to document E/M 
services first began using an EHR system between 2001 and 2011, as shown in Table 1.  
During that time, the largest percentage of physicians (22 percent) began using EHR 
systems in 2011, the year that CMS commenced its EHR incentive program.33  See Table 
A-2 in Appendix A for the percentage of physicians who first used EHR systems to 
document E/M services each year from 1981 to 2011.    
  
Table 1: Medicare Physicians Who First Used an EHR System to Document E/M Services 
From 2001 to 2011  
 
Percentage of  
Year 
Physicians 
2001  0.53%  
2002  0.80%  
2003  2.26%  
2004  5.59%  
2005  8.51%  
2006  7.85%  
2007  8.91%  
2008  10.64%  
2009  12.10%  
2010  15.82%  
2011  22.47% 
   Total   95.48%  
Source:  OIG analysis of EHR survey data,  
2012.  
 
Approximately 72 percent of Medicare physicians who used an EHR system to document 
E/M services always used it to document E/M services.  The remaining 28 percent used 
their EHR systems to document E/M services some of the time.  Specifically, 16 percent 
of Medicare physicians used their EHR systems to document E/M services more than  
   
                                                 
33 
This percentage of physicians in 2011 was statistically higher than all other percentages for the years listed in 
Table 1 at the 95-percent confidence level.  
Use of EHR Systems in 2011 Among Medicare Physicians  Providing E/M Services   OEI-04-10-00184         Page 8  Farzad Mostashari, M.D., Sc.M.; Marilyn Tavenner  
 
 
75 percent but less than 100 percent of the time, 8 percent from 50 to 75 percent of the 
time, and 4 percent less than 50 percent of the time. 
 
Although EHR systems can automatically assign codes for E/M services, 88 percent of 
Medicare physicians assigned codes manually in 2011.  The remaining 12 percent had 
codes assigned manually by staff (e.g., professional coders).   
 
Three of Every Four Medicare Physicians With an EHR System Used Certified 
EHR Technology To Document E/M Services 
Of the Medicare physicians who used EHR systems at their primary practice locations,  
73 percent used a certified EHR system to document E/M services in 2011.  Overall, 
physicians used more than 135 different EHR systems from more than 110 vendors.  See 
Table A-3 in Appendix A for the percentage of Medicare physicians who used specific 
EHR systems by vendor.  Sixty percent of Medicare physicians used a certified EHR 
system from one of nine vendors (see Table 2).  See Table A-4 in Appendix A for the 
percentage of Medicare physicians who used certified EHR systems by the nine vendors 
listed in Table 2. 
 
Table 2: Nine Vendors of Certified EHR Systems Used By Most Medicare Physicians to 
Document E/M Services in 2011  
 
  Percentage of   
  Vendor   Physicians  
 
Allscripts  10.90%  
 
  eClinicalWorks, LLC.   9.04%  
  GE Healthcare   8.64%  
 
NextGen Healthcare   8.24%  
 
Epic Systems Corporation   7.45%  
 
  Greenway Medical Technologies, Inc.  5.19%  
  Cerner Corporation  3.99%  
 
McKesson Corporation   3.72%  
 
Sage  3.06% 
 
   Total*  60.24%  
  *Total exceeds column sum because of rounding. 
Source:  OIG analysis of EHR survey data, 2012.  
 
 
 
 
 
 
 
Use of EHR Systems in 2011 Among Medicare Physicians  Providing E/M Services   OEI-04-10-00184         Page 9  Farzad Mostashari, M.D., Sc.M.; Marilyn Tavenner  
 
 
CONCLUSION 
  
ONC officials expressed interest in additional information about physicians use of EHR 
systems.  They also wanted to know how many and which EHR systems were being used 
and whether the Medicare physicians in our study were using certified EHR systems to 
document E/M services.  We provide this memorandum report to inform ONC about the 
use of both certified and noncertified EHR systems in 2011 among Medicare physicians 
who provided E/M services in 2010. Our results are consistent with CDCs 2011 annual 
report on the use of EHR technology among office-based physicians.   
 
Additionally, CMS may find this information helpful as it continues administering its 
EHR incentive program.  The use of EHR systems among Medicare physicians will likely 
continue to rise as more physicians participate in CMSs EHR incentive program.  Also, 
physicians will likely continue to adopt and implement certified EHR technology to avoid 
Medicare payment reductions starting in 2015.  Information in this report can also 
provide CMS with insights regarding its EHR incentive program.   
 
This report is being issued directly in final form because it contains no recommendations.  
If you have comments or questions about this report, please provide them within 60 days.  
Please refer to report number OEI-04-10-00184 in all correspondence.    
Use of EHR Systems in 2011 Among Medicare Physicians  Providing E/M Services   OEI-04-10-00184         Page 10  Farzad Mostashari, M.D., Sc.M.; Marilyn Tavenner 
 
  
Appendix A 
 
Table A- 1:  Sample Sizes, Point Estimates, and Confidence Intervals for Medicare 
Physicians Who Used an Electronic Health Record System in 2011  
 
Sample  Point  95-Percent Confidence 
Estimate Description  
Size  Estimate   Interval  
 
Medicare physicians using an electronic health 
record (EHR) system at their primary practice  1,472   56.73%   54.18%59.24%  
locations 
Medicare physicians using an EHR system to 
document evaluation and management (E/M)  835  90.06%   87.83%91.92%  
services  
Medicare physicians using an EHR system to 
document E/M services who first began using an  752  95.48%   93.73%96.75%  
EHR system between 2001 and 2011  
Medicare physicians using an EHR system to 
752  71.68%   68.34%74.79%  
document E/M services 100 percent of the time  
Medicare physicians using an EHR system to 
document E/M services more than 75 but less  752  15.96%   13.51%18.76%  
than 100 percent of the time  
Medicare physicians using an EHR system to 
document E/M services from 50 to 75 percent of   752  8.24%   6.48%10.44%  
the time 
Medicare physicians using an EHR system to 
document E/M services less than 50 percent of  752  4.12%   2.91%5.81%  
the time 
Medicare physicians manually assigning E/M 
752  87.77%   85.22%89.93%  
codes 
Medicare physicians whose staff manually  
752  12.23%   10.07%14.78%  
assign E/M codes 
Medicare physicians using a certified EHR 
752  73.01%   69.71%76.07%  
system at primary practice location 
Medicare physicians using a certified EHR 
752  60.24%   56.70%63.67%  
system from one of nine vendors*  
*The nine vendors were Allscripts, eClinicalWorks, LLC., GE Healthcare, Epic Systems Corporation, Greenway Medical  
Technologies, Inc., Cerner Corporation, McKesson Corporation, and Sage.  
Source:   Office of Inspector General (OIG) analysis of EHR survey data, 2012.  
 
 
   
Use of EHR Systems in 2011 Among Medicare Physicians  Providing E/M Services   OEI-04-10-00184         Page 11  Farzad Mostashari, M.D., Sc.M.; Marilyn Tavenner 
 
 
 Appendix A  
 
Table A- 2:  Point Estimates and Confidence Intervals of Medicare 
Physicians Who First Used an EHR System to Document E/M 
Services From 1981 to 2011 (n =752) 
 
Year  Point Estimate   95-Percent Confidence Interval    
 
1981   0.13%   0.02%0.94%  
1990   0.13%   0.02%0.94%  
1991   0.13%   0.02%0.94%  
1994   0.40%  0.13%1.23%  
1995   0.40%   0.13%1.23%  
1996   0.13%   0.02%0.94%  
1997   0.53%   0. 20%1.41%  
1998   1.20%   0.62%2.29%  
1999   0.27%   0.07%1.06%  
2000   1.20%   0. 62%2.29%  
2001   0.53%   0.20%1.41%  
2002   0.80%   0.36%1.77%  
2003   2.26%   1.40%3.61%  
2004   5.59%   4.15%7.48%  
2005   8.51%   6.71%10.73%  
2006   7.85%   6.12%10.00%  
2007   8.91%   7.07%11.17%  
2008   10.64%   8.62%13.06%  
2009   12.10%   9.95%14.64%  
2010   15.82%   13.38%18.62%  
2011   22.47%   19.62%25.60%  
     Total   100.00%   -- 
Source:  OIG analysis of EHR survey data, 2012. 
 
Use of EHR Systems in 2011 Among Medicare Physicians  Providing E/M Services   OEI-04-10-00184         Page 12  Farzad Mostashari, M.D., Sc.M.; Marilyn Tavenner 
 
 
Appendix A 
 
Table A- 3:  Point Estimates and Confidence Intervals for Medicare Physicians Who  
Used an EHR System by Vendor* (n=752)  
 
Point  95-Percent 
Vendor   EHR System  
Estimate   Confidence Interval  
 
Acura Medical Solutions, 
mMD.Net EHR   0.13%   0.02%0.94%  
Inc. 
Advanced Data Systems  MedicsDocAssistant  0.40%   0.13%1.23%  
Advanced Health  Advanced Health Management 
0.13%  0.02%0.94%  
Management Systems  Systems EHR 
Advanced MD  Advanced MD EHR   0.27%   0.07%1.05%  
Allmeds, Inc.   Allmeds EMR  0.66%   0.28%1.59%  
Allscripts   Allscripts Enterprise   0.53%   0.20%1.41%  
Allscripts   Allscripts MyWay  0.80%   0.36%1.76%  
Allscripts   Allscripts PayerPath  0.13%   0.02%0.94%  
Allscripts   Allscripts Professional  1.46%   0.81%2.62%  
Allscripts   Allscripts Tiger  0.13%   0.02%0.94%  
Allscripts   Did Not Specify  5.32%   3.93%7.17%  
Allscripts   MediNotes  0.53%   0.20%1.41%  
Allscripts   Sunrise Ambulatory  Care   0.13%   0.02%0.94%  
Sunrise Ambulatory  Care Module 
Allscripts   0.13%  0.02%0.94%  
Set 
Allscripts   Sunrise Clinical Manager   0.27%   0.07%1.05%  
Allscripts   TouchWorks  1.46%   0.81%2.62%  
Allscripts-Misys Healthcare  
MISYS Allscripts EHR  1.20%   0.62%2.28%  
Solutions, Inc.  
Altapoint Data Systems, 
Altapoint EHR  0.40%   0.13%1.23%  
LLC  
Altos Solutions, Inc.  OncoEMR  0.13%   0.02%0.94%  
AmazingCharts.com, Inc.  Amazing Charts  2.26%   1.41%3.60%  
American Medical Software   American Medical Software EMR   0.13%   0.02%0.94%  
Antek HealthWare, LLC   Alteer Office   0.80%   0.36%1.76%  
*Vendors use the terms EHR and electronic medical record (EMR) systems interchangeably.  
   continued on next page 
Use of EHR Systems in 2011 Among Medicare Physicians  Providing E/M Services   OEI-04-10-00184          
Page 13  Farzad Mostashari, M.D., Sc.M.; Marilyn Tavenner 
 
 
Appendix A 
 
Table A- 3:  Point Estimates and Confidence Intervals for Medicare Physicians Who  Used  
an EHR System by Vendor * (n=752) (Continued)  
 
Point  95-Percent 
Vendor   EHR System  
Estimate   Confidence Interval  
 
Aprima Medical Software, 
Aprima EHR  0.80%   0.36%1.76%  
Inc. 
ASP.MD Medical Office System 
ASP.MD, Inc.  0.13%   0.02%0.94%  
(AMOS)  
Bizmatics, Inc.   PrognoCIS EMR   0.27%   0.07%1.05%  
Cerner Corporation  Cerner PowerChart   3.59%   2.48%5.18%  
Cerner Corporation  Cerner PowerWorks   0.40%   0.13%1.23%  
ClearPractice  ClearPractice  0.13%   0.02%0.94%  
Community Computer 
MEDENT   2.13%   1.31%3.44%  
Service, Inc. 
Compulink Business 
Compulink  0.13%   0.02%0.94%  
Systems 
Comtron, Inc.  Medgen EHR   0.27%   0.07%1.05%  
Covemed Systems, Inc.  Covemed EMR   0.13%   0.02%0.94%  
Data Tec, Inc.   PowersoftMD   0.27%   0.07%1.05%  
Datanational   eConnect Portal   0.27%   0.07%1.05%  
DOX Podiatry   DOX Podiatry EHR   0.13%   0.02%0.94%  
eCast Corporation  eCast EMR   0.27%   0.07%1.05%  
eClinicalWorks, LLC   eClinicalWorks   9.04%   7.19%11.31%  
EDIMS, LLC  EDIMS  0.13%   0.02%0.94%  
EHR Scope, LLC   CareSeries EHR   0.40%   0.13%1.23%  
Elekta-IMPAC Medical 
Mosaiq  0.66%   0.28%1.59%  
Systems, Inc. 
e-MDs, Inc.  e-MDs Solution Series  0.27%   0.07%1.05%  
Emergisoft Corporation   Emergisoft EHR   0.13%   0.02%0.94%  
Encite, Inc.  Encite EHR  0.13%   0.02%0.94%  
*Vendors use the terms EHR and EMR systems interchangeably.  
   continued on next page 
Use of EHR Systems in 2011 Among Medicare Physicians  Providing E/M Services   OEI-04-10-00184          
Page 14  Farzad Mostashari, M.D., Sc.M.; Marilyn Tavenner 
 
 
 Appendix A 
 
Table A- 3:  Point Estimates and Confidence Intervals for Medicare Physicians Who  Used  
an EHR System by Vendor * (n=752)  (Continued)  
 
Point  95-Percent 
Vendor   EHR System  
Estimate   Confidence Interval  
 
Epic Systems Corporation   Epic Care  0.40%   0.13%1.23%  
Epic Systems Corporation   Epic Care Ambulatory EMR   6.91%   5.31%8.96%  
Epic Systems Corporation   Excellian  0.13%   0.02%0.94%  
Falcon, LLC   Falcon EHR   0.27%   0.07%1.05%  
First Insight Corporation   MaximEyes SQL   0.13%   0.02%0.94%  
Forerun, Inc.   Forerun EHR   0.13%   0.02%0.94%  
Gateway EDI   Gateway EDI   0.13%   0.02%0.94%  
GE Healthcare   Centricity EMR   6.38%   4.85%8.37%  
GE Healthcare   Centricity Practice Solution  1.86%   1.11%3.12%  
GE Healthcare   IDX  0.27%   0.07%1.05%  
GE Healthcare   Logician EMR  0.13%   0.02%0.94%  
GEMMS   GEMMS One   0.93%   0.44%1.94%  
Glenwood Systems, LLC  GlaceEMR   0.27%   0.07%1.05%  
gMed   gGastro EMR   0.13%   0.02%0.94%  
Greenway Medical 
PrimeSUITE EHR  5.19%   3.81%7.02%  
Technologies, Inc. 
Health Innovation 
Revolution EHR   0.27%   0.07%1.05%  
Technologies, Inc. 
Health IT Services Group   Acumen EHR   0.66%   0.28%1.59%  
Healthcare Management 
HMS Ambulatory EHR   0.27%   0.07%1.05%  
Systems, Inc. 
HealthFusion   MediTouch   0.27%   0.07%1.05%  
Healthland  Healthland EMR   0.13%   0.02%0.94%  
Holt Systems  eMedRec   0.27%   0.07%1.05%  
* Vendors use the terms EHR and EMR systems interchangeably.  
   continued on next page 
Use of EHR Systems in 2011 Among Medicare Physicians  Providing E/M Services   OEI-04-10-00184         Page 15  Farzad Mostashari, M.D., Sc.M.; Marilyn Tavenner 
 
 
Appendix A 
 
Table A- 3:  Point Estimates and Confidence Intervals for Medicare Physicians Who  Used  
an EHR System by Vendor * (n=752) (Continued)  
 
Point  95-Percent 
Vendor   EHR System  
Estimate   Confidence Interval  
 
iMedCORE   iMedCORE EMR  0.13%   0.02%0.94%  
Infinite Software Solutions, 
MD-Reports   0.13%   0.02%0.94%  
Inc. 
Infor-Med Medical 
Praxis EMR  0.53%   0.20%1.41%  
Information Systems, Inc. 
InteGreat, Inc.   IC-Chart   1.33%   0.72%2.45%  
Intelligent Medical 
IMO Diagnosis Code Check  0.13%   0.02%0.94%  
Objects, Inc. 
Internally Developed 
Internally Developed System   1.20%   0.62%2.28%  
System  
Intuitive Medical Software, 
Urochart EHR   0.13%   0.02%0.94%  
LLC  
iSALUS Healthcare   OfficeEMR   0.27%   0.07%1.05%  
ISM, Inc.  OmniMD   0.13%   0.02%0.94%  
iton  MedicsDocAssistant  0.40%   0.13%1.23%  
Kaiser Computers, Inc.  Drs Enterprise   0.13%   0.02%0.94%  
Medical and Practice 
Lake Superior Software, 
Management (MPM)  Suite  0.27%   0.07%1.05%  
Inc. 
MAGIC  
Liquid Medical Office, Inc.  Liquid EMR  0.13%   0.02%0.94%  
LSS Data Systems  LSS  0.27%   0.07%1.05%  
MacPractice, Inc.   MacPractice MD  0.13%   0.02%0.94%  
McKesson Corporation   Horizon Ambulatory  Care   0.66%   0.28%1.59%  
McKesson Corporation   Horizon Clinicals   0.27%   0.07%1.05%  
McKesson Corporation   iKnowmed EHR   0.80%   0.36%1.76%  
McKesson Corporation   Medisoft Clinical   0.40%   0.13%1.23%  
McKesson Corporation   Practice Partner Patient Records   1.46%   0.81%2.62%  
McKesson Corporation   Did Not Specify  0.13%   0.02%0.94%  
* Vendors use the terms EHR and EMR systems interchangeably.  
   continued on next page 
 
Use of EHR Systems in 2011 Among Medicare Physicians  Providing E/M Services   OEI-04-10-00184         Page 16  Farzad Mostashari, M.D., Sc.M.; Marilyn Tavenner 
 
 
Appendix A 
 
Table A- 3:  Point Estimates and Confidence Intervals for Medicare Physicians Who  Used  
an EHR System by Vendor * (n=752) (Continued)  
 
Point  95-Percent 
Vendor   EHR System  
Estimate   Confidence Interval  
 
MD Productivity, Inc.  MD Dictate  0.13%   0.02%0.94%  
MED3000   MED3000   0.40%   0.13%1.23%  
Medamation, LLC  Medamation   0.13%   0.02%0.94%  
MedAptus, Inc.  MedAptus EMR   0.13%   0.02%0.94%  
MedcomSoft  MedcomSoft Record   0.13%   0.02%0.94%  
Medhost, Inc.  Medhost  0.27%   0.07%1.05%  
Medical Informatics 
Did Not Specify  0.13%   0.02%0.94%  
Engineering  
Medical Information 
MEDITECH   0.40%   0.13%1.23%  
Technology, Inc. 
Medical Software  
IMS EMR  0.66%   0.28%1.59%  
Associates  
MedInformatix Enterprise Practice 
MedInformatix  0.93%   0.44%1.94%  
Management  
MediSYS  MediSYS EHR  0.40%   0.13%1.23%  
Meditab  IMS Clinical   0.13%   0.02%0.94%  
meridianEMR, Inc.  meridianEMR   0.80%   0.36%1.76%  
Microfour, Inc.   PracticeStudio  0.27%   0.07%1.05%  
Navinet, Inc.  Navinet EMR  0.13%   0.02%0.94%  
NexTech Systems, Inc.  NexTech   0.13%   0.02%0.94%  
NextGen Healthcare   NextGen   8.24%   6.48%10.43%  
Noteworthy Medical 
NetPracticeEHRweb   0.13%   0.02%0.94%  
Systems, Inc. 
OCERIS, Inc.   FlexMedical  0.13%   0.02%0.94%  
Office Ally  Office Ally EHR 24/7  0.27%   0.07%1.05%  
* Vendors use the terms EHR and EMR systems interchangeably.  
   continued on next page 
   
Use of EHR Systems in 2011 Among Medicare Physicians  Providing E/M Services   OEI-04-10-00184         Page 17  Farzad Mostashari, M.D., Sc.M.; Marilyn Tavenner 
 
  
Appendix A 
 
Table A- 3:  Point Estimates and Confidence Intervals for Medicare Physicians Who  Used  
an EHR System by Vendor * (n=752) (Continued)  
 
Point  95-Percent 
Vendor   EHR System  
Estimate   Confidence Interval  
 
Practice Fusion, Inc.  Practice Fusion  1.73%   1.01%2.95%  
Prime Clinical Systems  Patient Chart Manager   0.40%   0.13%1.23%  
ProMED Clinical Systems  ProMED  0.40%   0.13%1.23%  
Propractica, Inc.  StreamlineMD EMR  0.13%   0.02%0.94%  
Pulse, Inc.  Pulse EHR  0.66%   0.28%1.59%  
QuadraMed   QuadraMed EHR   0.13%   0.02%0.94%  
Quest Diagnostics 
Care 360   0.53%   0.20%1.41%  
Incorporated  
Sage  Sage Intergy EHR  3.06%   2.04%4.56%  
Siemans  INVISION   0.13%   0.02%0.94%  
Siemans  Soarian   0.27%   0.07%1.05%  
SOAPware, Inc.  SOAPware   1.73%   1.01%2.95%  
SRS Software, Inc.  SRS Chart Manager   0.66%   0.28%1.59%  
STI Computer Services, 
ChartMaker Clinical  0.40%   0.13%1.23%  
Inc. 
SuccessEHS   SuccessEHS   0.53%   0.20%1.41%  
Treasure Coast 
HealthMatics EHR  1.46%   0.81%2.62%  
Management Group 
T-System, Inc.  T-System   0.13%   0.02%0.94%  
U.S. Department of  Computerized Patient Record 
0.13%   0.02%0.94%  
Veterans Affairs   System  
Ulrich Medical Concepts  Team Chart Concept  0.27%   0.07%1.05%  
University of California Los 
UCLA Healthcare System 
Angeles Healthcare  0.13%   0.02%0.94%  
Medical Record  
System  
Urgent Care Works  Urgent Care Works EMR  0.13%   0.02%0.94%  
Varian Medical Systems  ARIA  0.27%   0.07%1.05%  
* Vendors use the terms EHR and EMR systems interchangeably.  
  continued on next page 
Use of EHR Systems in 2011 Among Medicare Physicians  Providing E/M Services   OEI-04-10-00184         Page 18  Farzad Mostashari, M.D., Sc.M.; Marilyn Tavenner 
 
  
Appendix A 
 
Table A- 3:  Point Estimates and Confidence Intervals for Medicare Physicians Who  
Used an EHR System by Vendor * (n=752) (Continued)  
 
Point  95-Percent Confidence 
Vendor   EHR System  
Estimate   Interval  
 
VersaForm Corporation   VersaForm EHR   0.13%   0.02%0.94%  
Visionary Medical 
Dream EMR   0.27%   0.07%1.05%  
Systems, Inc. 
Waiting Room Solutions 
Waiting Room Solutions  0.13%   0.02%0.94%  
EHR 
Wyoming Department of 
Total Health Record   0.13%   0.02%0.94%  
Health 
Dont Know   Dont Know   0.27%   0.07%1.05%  
Unknown  CarePlus  0.13%   0.02%0.94%  
Unknown  digital medicine   0.13%   0.02%0.94%  
Unknown  MD Logic  0.13%   0.02%0.94%  
Unknown  Urgent Care   0.13%   0.02%0.94%  
* Vendors use the terms EHR and EMR systems interchangeably.  
Source:   OIG analysis of EHR survey  data, 2012.   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Use of EHR Systems in 2011 Among Medicare Physicians  Providing E/M Services   OEI-04-10-00184         Page 19  Farzad Mostashari, M.D., Sc.M.; Marilyn Tavenner 
 
 
Appendix A 
 
Table  A- 4:  Point Estimates and Confidence Intervals for Nine Vendors With Certified 
EHR Systems (n =752)  
Point  95-Percent Confidence 
Vendor  
Estimate   Interval  
Allscripts   10.90%   8.87%13.34%  
Cerner Corporation  3.99%   2.80%5.65%  
eClinicalWorks, LLC.   9.04%   7.19%11.31%  
Epic Systems Corporation   7.45%   5.78%9.55%  
GE Healthcare   8.64%   6.84%10.87%  
Greenway Medical Technologies, Inc.  5.19%   3.81%7.02%  
McKesson Corporation   3.72%   2.58%5.34%  
NextGen Healthcare   8.24%   6.48%10.43%  
Sage  3.06%   2.04%4.56%  
Source:   OIG analysis of EHR survey  data, 2012.  
Use of EHR Systems in 2011 Among Medicare Physicians  Providing E/M Services   OEI-04-10-00184