U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES 

Centers for Disease Control and Prevention 

National Center for Health Statistics 

Number 75 n May 20, 2014

Trends in Electronic Health Record System
 

Use Among Office-based Physicians:
 

United States, 2007–2012
 by Chun-Ju Hsiao, Ph.D., M.H.S., Agency for Healthcare Research & Quality;

Esther Hing, M.P.H., and Jill Ashman, Ph.D., National Center for Health Statistics

Abstract

Objectives—This report presents trends in the adoption of electronic health

records (EHRs) by office-based physicians during 2007–2012. Rates of adoption

are compared by selected physician and practice characteristics.

Methods—The National Ambulatory Medical Care Survey (NAMCS) is

based on a national probability sample of nonfederal office-based physicians who

see patients in an office setting. Prior to 2008, data on physician characteristics

were collected through in-person interviews with physicians. To increase the

sample for analyzing physician adoption of EHR systems, starting in 2008,

NAMCS physician interview data were supplemented with data from an EHR

mail survey. This report presents estimates from the 2007 in-person interviews,

combined 2008–2010 data from both the in-person interviews and the EHR mail

surveys, and 2011–2012 data from the EHR mail surveys. Sample data were

weighted to produce national estimates of office-based physician characteristics

and their practices.

Results—In 2012, 71.8% of office-based physicians reported using any type

of EHR system, up from 34.8% in 2007. In 2012, 39.6% of physicians had an

EHR system with features meeting the criteria of a basic system, up from 11.8%

in 2007; 23.5% of office-based physicians had an EHR system with features

meeting the criteria of a fully functional system in 2012, up from 3.8% in 2007.

In 2007, a wide gap existed in use of any type of EHR system between

physicians in practices with 11 or more physicians (74.3%) compared with

physicians in smaller practices (20.6% among solo practitioners); the gap,

however, narrowed during 2007–2012. In 2007, no significant gap was observed

in adoption of a fully functional system between primary care (4.7%) and

nonprimary care physicians (2.8%); the gap, however, widened over time (27.9%

compared with 19.4% in 2012). The difference in adoption of a fully functional

system between physicians in practices with 11 or more physicians compared

with solo practitioners was 10.4 percentage points in 2007; the gap widened to

30.6 percentage points in 2012.

Keywords: electronic medical records • National Ambulatory Medical Care

Survey

Introduction

The 2009 Health Information

Technology for Economic and Clinical

Health (HITECH) Act authorized

incentive payments through Medicare

and Medicaid to health care providers

that use certified electronic health

record (EHR) systems to achieve

specified improvements in care

delivery (1). Eligible Medicare and

Medicaid physicians may receive

incentive payments over 5 years, starting

in 2011, if they demonstrate that they

are using a certified EHR system that

meets 15 Stage 1 Core Set objectives

and 5 of 10 Menu Set objectives. A

federally funded regional extension

center (REC) program was created to

provide physicians with assistance in

purchasing and implementing EHR

systems, training staff, and addressing

how they use EHR systems when they

see patients (2). The REC program seeks

to support 100,000 primary care

providers, with particular emphasis

given to practices with fewer than 10

clinicians and to clinicians who work in

settings that tend to serve uninsured,

underinsured, and medically underserved

populations.

The terms electronic medical record

and electronic health record have been

used interchangeably over time. For
Page 2 National Health Statistics Reports n Number 75 n May 20, 2014

simplicity, this report refers to these

records as EHRs. This report describes

trends in the adoption of EHR systems

by office-based physicians from 2007

through 2012. Three measures of EHR

adoption are examined: use of any type

of EHR system, and the availability of

an EHR system that had features

meeting the criteria of a basic or a fully

functional system (3). EHR adoption

trends by selected physician and practice

characteristics from 2007 to 2012

are also reported. Information on

adoption by physician and practice

characteristics in prior years can be

found elsewhere (4–7).

Methods

The National Ambulatory Medical

Care Survey (NAMCS) is an annual

probability survey of nonfederal,

office-based physicians providing direct

patient care, excluding radiologists,

anesthesiologists, and pathologists. The

survey is conducted by the Centers for

Disease Control and Prevention’s (CDC)

National Center for Health Statistics

(NCHS). A sample of office-based

physicians who reported that they were

in direct patient care was taken from the

master files of the American Medical

Association and the American

Osteopathic Association. Through 2011,

the sample design for the core NAMCS

included 112 geographic primary

sampling units (PSUs). Within those

PSUs, physicians were stratified by

specialty, and a sample of physicians

was selected. Physicians were randomly

assigned to one of 52 reporting weeks

throughout the year. Physician data for

the core NAMCS were collected

through in-person interviews.

Since 2008, in addition to the core

NAMCS, a supplemental mail survey on

EHR systems has been conducted. In

2008 and 2009, a sample of 2,000

physicians was selected each year using

the same sampling design as the core

NAMCS. Starting in 2010, to allow for

state-level estimates, the EHR mail

survey sample size was increased

fivefold: A sample of 10,302 physicians

was selected each year from the 50

states and the District of Columbia.

EHR adoption estimates by state from

2010 to 2012 have been published

elsewhere (8–11). From 2008 to 2012,

EHR mail surveys were conducted each

year during a 4- or 5-month period

between February and August.

Nonrespondents to the EHR mail survey

received follow-up telephone calls, and

when possible, the survey was

completed by telephone.

See Table A for source of data,

sample size, and response rate for each

survey year. Data from the core

NAMCS and EHR mail surveys are

combined for 2008, 2009, and 2010.

Additional information about NAMCS,

including the questionnaires used, is

available from: http://www.cdc.gov/nchs/

ahcd.htm.

Physician and practice characteristics

used in this report include physician

age (under 35, 35–44, 45–54, 55–64,

and 65 and over); sex; specialty type

[primary care specialty (general and

family practice, internal medicine,

pediatrics, and obstetrics and

gynecology), surgical specialty (includes

all surgical specialties such as urology,

plastic surgery, and abdominal surgery),

and medical specialty (includes all

nonsurgical medical specialties such as

dermatology, cardiovascular disease, and

neurology)]; practice size (solo, partner,

3–5, 6–10, and 11 or more physicians);

breadth of specialization (singlespecialty and multispecialty); practice

ownership [physician or physician

group, health maintenance

organization (HMO), community health

center, and other]; percentage of the

practice’s revenue received from

Medicaid (less than 5%, 5%–19%, 20%

or more); geographic region (Northeast,

Midwest, South, and West); and

metropolitan status [metropolitan

statistical area (MSA) and not an MSA].

Practice characteristics including size,

ownership, and breadth of specialization

were reported for the location where the

sampled physician saw the most

ambulatory patients. These estimates

may not accurately reflect practice size

and breadth if the sampled location is

different from other locations.

Both the core NAMCS and the

EHR mail survey contained a series of

questions about EHR systems including

current and planned use of EHR

systems, availability of computerized

features, intent to apply for a Meaningful

Use incentive payment (available in

2010–2012), and participation in

exchanging patient clinical summaries

electronically with other providers

(available in 2011–2012). (For the actual

questions used in the survey, see

http://www.cdc.gov/nchs/ahcd/

ahcd_survey_instruments.htm#namcs.)

The estimate of any type of EHR system

was obtained from ‘‘yes’’ responses to the

question, ‘‘Does this practice use

electronic medical records or electronic

health records (not including billing

records)?’’ It was assumed that missing

data on the question about using an EHR

system meant that the responding

physician did not use any type of EHR

system; similarly, it was assumed that

missing data on any of the individual

computerized features meant that those

specific features were not part of the

responding physician’s system. These

assumptions could result in underestimates

of the EHR adoption rate.

The features of computerized

systems within physician practices were

reported by respondents. All respondents

were asked whether their practice had a

system with each specific computerized

feature, regardless of whether they

actually used an EHR system. The list

Table A. Source of data, sample size, and response rate, by survey year

Year Data source

Responding

sample size

Response rate

(percent)

2007 ..............

2008 ..............

2009 ..............

2010 ..............

2011 ..............

2012 ..............

In-person interview

In-person interview and mail survey

In-person interview and mail survey

In-person interview and mail survey

Mail survey

Mail survey

1,743

2,338

2,646

6,121

4,326

4,545

72

65

70

67

61

65

SOURCE: CDC/NCHS, National Ambulatory Medical Care Survey (NAMCS) and NAMCS-Electronic Health Record Survey.
National Health Statistics Reports n Number 75 n May 20, 2014 Page 3

of computerized features included in the

survey changed between 2007 and 2012

to reflect emerging Meaningful Use

priorities and definitions. Over the

6-year period, the number of features

addressed in the survey ranged from

16 to 24. Data on the following

11 computerized features were

consistently collected each year from

2007 through 2012: 1) recording patient

history and demographic information,

2) recording patient problem lists,

3) ordering prescriptions, 4) providing

warnings of drug interactions or

contraindications, 5) electronically

sending prescriptions to the pharmacy,

6) ordering laboratory results,

7) electronically sending test orders,

8) viewing laboratory results, 9) viewing

imaging results, 10) recording clinical

notes, and 11) providing guideline-based

interventions or screening test

reminders.

Using definitions developed by

health information technology

experts (3), these detailed features were

used to define basic and fully functional

systems. The features of a basic system

are a subset of the features of a fully

functional system. Due to survey item

changes across the years, basic and fully

functional systems include slightly

different features from 2010 through

2012 (Table B). During 2007–2009, a

basic system included six features

(recording patient history and

demographic information, clinical notes,

and patient problem lists; viewing

laboratory and imaging results; and

ordering prescriptions). During

2010–2012, a basic system included one

additional feature: for 2010, recording a

list of medications, and for 2011 and

2012, recording a list of medications

and allergies. During 2007–2009, a fully

functional system consisted of

14 features, including all of the features

of a basic system, plus 8 additional

features: medical history and follow-up

notes, providing warnings for drug

interactions or contraindications,

electronically sending prescriptions to

the pharmacy, ordering laboratory tests,

electronically sending test orders,

providing reminders for guideline-based

interventions, providing out-of-range test

levels (omitted from 2011 and 2012),

and having electronic images returned

(omitted from 2010–2012). For both

basic and fully functional systems, even

if a feature was reported as turned off, it

was still considered available for use

within the system.

Note that changes in the survey

items (Table B) might have affected

estimates of fully functional systems

from 2007 through 2012. The

differences, however, were small.

For 2007–2012, inclusion of all

available items to estimate adoption of

these systems resulted in lower

percentages (3.8%–23.5%) meeting

the fully functional criteria than when

defined with the 11 items available

every year during the period

[4.6%–23.9% (data not shown)].

Changes in estimates of basic systems

were minimal because only one item

was added. From 2009 to 2010, when

the additional feature (recording a

list of medications) was collected and

included in the definition of a basic

system, the difference in estimates

was 0.5 percentage points.

This report presents national

estimates of EHR adoption among

office-based physicians. Because

NAMCS is based on a multistage

sample of physicians, compound

sampling weights were applied to make

national estimates of EHR adoption and

corresponding estimates of sampling

error (12). The NAMCS physician

sample weight includes three basic

components: 1) inflation by reciprocals

of the sampling probabilities,

2) adjustment for physician nonresponse,

and 3) a calibration ratio adjustment

between the number of physicians in the

sample frame from the time the sample

was selected until the time that data

were collected. Statements of differences

in estimates are based on t tests with

significance at the p less than 0.05 level.

A weighted least-squares regression

analysis was used to determine the

significance of trends by year. For the

weighted least-squares test, the null

hypothesis is that the slope, β, of the

regression line does not significantly

differ from zero (i.e., H0 : ß = 0, and

HA : ß ≠ 0). In this modified

least-squares regression, each estimate is

weighted by the inverse of the standard

error (13). Terms relating to differences

such as ‘‘increased’’ or ‘‘decreased’’

indicate that the difference is statistically

Table B. Survey items defining basic and fully functional electronic medical record or

electronic health record systems

Fully

Basic functional

Features of EMR or EHR systems system1 system1

Record patient history and demographic information .................. Yes Yes

Patient problem lists .................................... Yes Yes

Order prescriptions....................................... Yes Yes

Warnings for drug interactions or contraindications.................. . . . Yes

Prescriptions sent to pharmacy electronically ..................... . . . Yes

Order lab tests ......................................... . . . Yes

Test orders sent electronically .............................. . . . Yes

View lab results......................................... Yes Yes

Out-of-range values highlighted2 .............. .............. . . . Yes

View imaging results...................................... Yes Yes

Electronic images returned3 ................ ................ . . . Yes

Orders for radiology tests4 .................................. . . . Yes

Record clinical notes ..................................... Yes Yes

Medical history and follow-up notes3 .......................... . . Yes

List of medications5 .................. .................. Yes Yes

Provide guideline-based interventions or screening test reminders ......... . . . Yes

. . . Category not applicable.
 1Based on definition presented in Health Information Technology in the United States: Where We Stand, 2008, Robert Wood
 

Johnson Foundation.
 2Available only in 2007–2010.
 3Available only in 2007–2009.
 4Available on 2010 mail survey, but unavailable on 2010 in-person survey. This item was not included in the 2010 estimate of
 

physicians with fully functional systems due to its unavailability on the in-person survey.
 5First available in 2010.
 

NOTES: EMR is electronic medical record. EHR is electronic health record. Survey items are from the National Ambulatory
 

Medical Care Survey.
 
80 

60 

Percent 40 

20 

0 

Fully functional 

system3 

Basic system2 

Any type of EMR 

or EHR system1 

18.2 

71.8 

39.6 

11.8 

23.5 

3.8 

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 

1

Either all or partially electronic and excludes systems used solely for billing. 


2

Includes a minimal list of necessary EHR features.
 

3

Includes a more complete list of necessary EHR features. 


NOTES: EMR is electronic medical record and EHR is electronic health record. See Table B in this report for definitions of 


basic and fully functional systems. Data include nonfederal office-based physicians and exclude radiologists, 


anesthesiologists, and pathologists.
 

SOURCE: CDC/NCHS, National Ambulatory Medical Care Survey, 2001–2012.
 

Figure 1. Office-based physicians with an electronic medical record or electronic health

record system: United States, 2001–2012

Page 4	 National Health Statistics Reports n Number 75 n May 20, 2014

significant. A lack of comment

regarding the difference does not mean

that the difference was tested and found

to be not significant.

Results	 

Office-based physician

characteristics

+ Table 1 shows the percent distribution

of office-based physicians for 2007

through 2012 by selected physician

characteristics. From 2007 to 2012,

the percentage of physicians who

were 45 and under decreased while

the percentage of physicians who

were 54 and over increased. The

largest increase occurred among

physicians who were 65 and

over.

+	 During the same period, the

percentage of physicians who were

female increased by 20%, while the

percentage of physicians who were

male decreased by 7%. In 2012,

about 70% of physicians were male.

+	 For 2007–2012, the percentage of

physicians working in practices with

11 or more physicians increased by

84%, while the percentage of

physicians working in practices with

2 physicians decreased by 24%. In

2012, about two-fifths of physicians

worked in a practice with 6 or more

physicians (37.2%).

+	 The percentage of physicians who

worked in multispecialty practices

increased by 27% during the same

time period. In 2012, the majority of

physicians worked in a singlespecialty practice (73.9%).

+	 For 2007–2012, the percentage of

physicians working in a physician- or

physician group-owned practice

decreased by 22%, while the

percentage of physicians working in

practices owned by a medical or

academic health center, or other

health care corporation (other

ownership) increased by 140%. In

2012, more than one-half of

physicians worked in a practice

owned by a physician or physician

group (63.1%).

+	 From 2007 to 2012, no significant

changes were observed in the

percentage of physicians by specialty

type (primary care, surgical, or

medical), geographic region, and

metropolitan status. In 2012, 48.5%

of physicians were in primary care

specialties, 22.5% were in surgical

care specialties, and 29.1% were in

medical care specialties.

+ From 2007 to 2012, most physicians

worked at a practice located in an

MSA, ranging from 87.8% to 90.4%.

Use of any type of EHR

system

+ Excluding systems used solely for

billing, 71.8% of office-based

physicians reported using any type of

EHR system in 2012, up from 57.0%

in 2011 and 34.8% in 2007. From

2001 to 2012, use of any EHR

system increased 295% (Figure 1).

+ From 2007 through 2012, use of any

type of EHR system increased in all

physician and practice categories,

with the exception of HMO-owned

practices (Table 2).

+ The difference in use of any type of

EHR system between primary care

physicians and nonprimary care

physicians became significant in
 

2010 (Figure 2).
 

+	 Use of any type of EHR system was

higher among primary care physicians

than nonprimary care physicians. In

2012, 74.9% of primary care physicians

used any type of EHR system, while

66.5% of physicians with surgical

specialties and 70.7% of physicians

with medical specialties used any type

of EHR system (Table 2).

+	 The difference in use of any type of

EHR system between physicians in

bigger practices and smaller practices

was significant during 2007–2012

(Figure 2). In 2007, the percentage

using any type of EHR system was

74.3% for physicians working in

practices with 11 or more physicians

and 20.6% for solo practitioners

(Table 2). While use of any type of

EHR system increased among all

practice size categories, the gap in

use of any type of EHR system

narrowed between physicians in the

largest practice size category (11 or

more physicians) and solo

practitioners between 2007 and 2012,

from a 53.7 percentage point
100 100

80 80

Nonprimary care physicians 

Primary care physicians 

Percent 

2007 2008 2009 20101 20111 20121 

11 or more physicians 

6–10 physicians 

3–5 physicians 

Partner 

Solo 

2007 2008 2009 2010 2011 2012 

Practice size2 

Percent60 

40 

60 

40 

20 20

0 0 

Physician specialty 

1

Difference in the percentage of physicians by specialty is statistically significant (p < 0.05).
 2

Difference in the percentage of physicians in practices with 11 or more physicians and solo physicians is statistically significant (p < 0.05) for all years.
 

NOTES: Any type of electronic medical record (EMR) or electronic health record (EHR) system is one that is either all or partially electronic and excludes systems used solely for billing. All 


trends for use of any EMR or EHR system have significant increases (p < 0.05). Primary care includes family practice, pediatrics, obstetrics and gynecology, and internal medicine. Practice
 

size is associated with the location where the physician saw the most ambulatory care patients; this variable may not accurately reflect practice size if the sampled location is different from
 

other locations. Data include nonfederal office-based physicians and exclude radiologists, anesthesiologists, and pathologists.
 

SOURCE: CDC/NCHS, National Ambulatory Medical Care Survey, 2007–2012.
 

Figure 2. Use of any type of electronic medical record or electronic health record system, by physician specialty and practice size:

United States, 2007–2012

National Health Statistics Reports n Number 75 n May 20, 2014	 Page 5

difference in 2007 to a 35.0

percentage point difference in 2012.

+	 Throughout the period of this report,

use of any type of EHR system was

highest among physicians in HMOowned practices (86.1%–97.2%) and

lowest among physicians in physicianowned practices (31.4%–66.5%)

(Table 2). Consequently, the rate of

increased use of EHRs was slower

among physicians in HMO-owned

practices, which led to a smaller gap in

EHR adoption between physicians in

HMO-owned practices and other

ownership categories.

+	 Each year during 2007–2012, use

of any type of EHR system was

higher among physicians working

in multispecialty practices

(52.5%–86.8%) than among

physicians working in single-specialty

practices (30.3%–66.5%).

+	 In 2012, among the four geographic

regions, physicians in the West

had the highest use of any type of

EHR system (78.9%) compared with

68.6%–71.0% in the remaining

regions).

Adoption of a basic system

+ Physician and practice characteristics

associated with adoption of a basic

system in 2012 were generally the

same as those associated with use of

any type of EHR system (Table 3).

+ In 2012, 39.6% of physicians had an

EHR system with features that met

the criteria of a basic system, up from

11.8% in 2007 (Figure 1). Increased

adoption of a basic system was

widespread from 2007 through 2012,

with adoption increasing in all

physician and practice categories

between 2007 and 2012. The increase

ranged from 81% among physicians

working in HMO-owned practices,

where adoption was already high in

2007, to 616% among physicians

working in the Northeast (Table 3).

+ From 2007 to 2012, adoption of

a basic system increased for all

physician specialty categories; the

rate of increase, however, differed

(Table 3). Starting in 2010, adoption

of a basic system was significantly

higher among primary care physicians

than nonprimary care physicians
 

(Figure 3).
 

+	 From 2007 to 2012, adoption of a

basic system increased for all practice

size categories (Figure 3), but the rate

of increase differed among the

categories. The difference in adoption

of a basic system between the largest

practice size category (11 or more)

relative to solo practitioners widened

from a 28.4 percentage point

difference in 2007 to a 39.2

percentage point difference in

2012 (Table 3). In 2007, physicians in

practices with six or more

physicians (6–10 and 11 or more)

were more likely than solo

practitioners to adopt a basic system.

However, by 2012, the gap between

solo practitioners and other

physicians was observed even for

physicians in practices with three or

more physicians (3–5, 6–10, and 11

or more), suggesting that solo

practitioners may face unique

challenges to EHR adoption.
Nonprimary care physicians 

Primary care physicians 

Percent 

0 

10 

20 

30 

40 

50 

60 

70 

Percent 

0 

10 

20 

30 

40 

50 

60 

70 

11 or more physicians 

6–10 physicians 

3–5 physicians 

Partner 

Solo 

20071 2008 2009 20101 20111 20121 2007 2008 2009 2010 2011 2012 

Physician specialty Practice size2 

1

Difference in the percentage of physicians by specialty is statistically significant (p < 0.05). 2

Difference in the percentage of physicians in practices with 11 or more physicians and solo physicians is statistically significant (p < 0.05) for all years.
 

NOTES: See Table B in this report for definition of a basic system. All trends for adoption of a basic system by physician specialty and practice size have significant increases (p < 0.05).
 

Primary care includes family practice, pediatrics, obstetrics and gynecology, and internal medicine. Practice size is associated with the location where the physician saw the most
 

ambulatory care patients; this variable may not accurately reflect practice size if the sampled location is different from other locations. Data include nonfederal office-based physicians
 

and exclude radiologists, anesthesiologists, and pathologists.
 

SOURCE: CDC/NCHS, National Ambulatory Medical Care Survey, 2007–2012.
 

Figure 3. Adoption of a basic electronic medical record or electronic health record system, by physician specialty and practice size:

United States, 2007–2012

Page 6	 National Health Statistics Reports n Number 75 n May 20, 2014

Adoption of a fully

functional system

+	 From 2007 to 2012, physician and

practice characteristics associated

with the adoption of a fully

functional system were generally the

same as those associated with having

a basic EHR system (Table 4). The

adoption of a fully functional system

increased for all physician and

practice categories during 2007–2012.

+	 In 2012, 23.5% of physicians had an

EHR system with features meeting

the criteria of a fully functional

system, up from 3.8% in 2007

(Figure 1).

+	 For 2007–2012, adoption of a fully

functional system increased for both

primary care and nonprimary care

physicians (Figure 4). Starting in

2009, primary care physicians were

significantly more likely than

nonprimary care physicians to adopt a

fully functional system; the gap in

adoption of a fully functional system

between primary care and nonprimary

care physicians increased from a

3.0 percentage point difference in

2009 to an 8.5 percentage point

difference in 2012 (Table 4).

+ Adoption of a fully functional system

increased among all practice size

categories. From 2007 through 2012,

the difference in adoption of a fully

functional system by physicians in

the largest practice size category (11

or more) relative to solo practitioners

widened from a 10.4 percentage point

difference to a 30.6 percentage point

difference. In 2007, physicians in

practices with six or more physicians

(6–10 and 11 or more) were

significantly more likely than solo

practitioners to adopt a fully

functional system. However, by 2012,

the gap in adoption of a fully

functional system between solo

practitioners and larger practices was

observed even for practices with three

or more physicians (3–5, 6–10, and

11 or more), again suggesting that

solo practitioners may face unique

barriers to EHR adoption.

Features of computerized

systems

+	 The survey was initially designed to

collect data on computerized features

that defined basic systems and fully

functional systems (Table B). Starting

in 2010, data on additional

computerized features were collected

to assess physicians’ readiness to

meet Stage 1 Meaningful Use

objectives; this resulted in the survey

having different lists of features

between 2007 and 2012 (Table 5).

Table C presents Meaningful Use

Stage 1 Core Set objectives and

corresponding 2012 NAMCS survey

items on EHR system features.

During 2007–2012, data on 11

computerized features were

consistently collected each year and

are the focus of the trend analysis.

+	 Overall, 19.5% of all physicians in

2012 had computerized systems ready

to support 13 of 15 Meaningful Use

Stage 1 Core Set objectives.

+	 A higher percentage of physicians

with fully functional systems had
Percent 

Percent

0 

5 

10 

15 

20 

25 

30 

35 

40 

45 

Nonprimary care physicians 

Primary care physicians 

0 

5 

10 

15 

20 

25 

30 

35 

40 

45 

11 or more physicians 

6–10 physicians 

3–5 physicians 

Partner 

Solo *

*

*

*

2007 2008 20091 20101 20111 20121 2007 20082 20092 20102 20112 20122 

Physician specialty Practice size 

* Figure does not meet standards of reliability or precision. 

1

Difference in the percentage of physicians by specialty is statistically significant (p < 0.05).
 2

Difference in the percentage of physicians in practices with 11 or more physicians and solo physicians is statistically significant (p < 0.05).
 

NOTES: See Table B in this report for definition of a fully functional system. All trends for adoption of a fully functional system by physician specialty and practice size have significant
 

increases (p < 0.05). Primary care includes family practice, pediatrics, obstetrics and gynecology, and internal medicine. Practice size is associated with the location where the physician
 

saw the most ambulatory care patients; this variable may not accurately reflect practice size if the sampled location is different from other locations. Data include nonfederal office-based
 

physicians and exclude radiologists, anesthesiologists, and pathologists.
 

SOURCE: CDC/NCHS, National Ambulatory Medical Care Survey, 2007–2012.
 

Figure 4. Adoption of a fully functional electronic medical record or electronic health record system, by physician specialty and practice

size: United States, 2007–2012

National Health Statistics Reports n Number 75 n May 20, 2014	 Page 7

computerized systems ready to meet

Stage 1 Core Set objectives (54.9%)

than physicians with basic systems

(37.5%) and physicians using any

type of EHR system (26.8%).

+	 Among the data on 11 features

collected each year, electronically

sending prescriptions to the pharmacy

had the largest percentage increase in

availability (358%), followed by

warnings of drug interactions or

contraindications (254%), and

ordering prescriptions (169%).

+	 Electronically sending prescriptions to

the pharmacy and ordering

prescriptions were two of the five

features that were most likely to be

available in a computerized system

in 2012.

+	 Recording patient history and

demographic information had the

smallest percentage increase (7%)

between 2007 and 2012, perhaps

because the availability of this

feature was already high (73.9%)

in 2007.

Discussion

In this report, adoption of three

types of EHR systems was discussed:

any type of EHR system, a basic

system, and a fully functional system.

The first measure was reported by the

physician as the EHR system used by

the practice, while ‘‘basic system’’ and

‘‘fully functional system’’ were defined

by functionalities that the system had.

The difference in the percentage of

physicians having a basic system and

those using any type of EHR system

(which could be either all electronic or

part electronic and part paper) may

reflect differences in the availability

and use of specific features of a system,

as well as a time lag between installing

a new system and using it (14).

A previous study found that it took

more than 2 years from the installation

date for physicians in a large practice to

actually use a new commercial EHR

system (15).

The federal government has been

encouraging adoption of health

information technology by physicians

and hospitals for the last decade. The

Medicare and Medicaid EHR incentive

programs authorized by the 2009

HITECH Act provide incentive

payments to health care providers that

demonstrate ‘‘meaningful use’’ of

certified EHR systems. Starting in 2011,

eligible Medicare physicians could

receive up to $44,000 over 5 years (16).

Eligible Medicaid physicians could

receive up to $63,000 over a 6-year

period that could begin as late as 2016

and run through 2021. The Medicare

and Medicaid EHR Incentive Programs

are staged in three steps with increasing

requirements for participation. Stage 1

of the EHR Incentive Programs began in

2011 and Stage 2 began in 2014.

Basic and fully functional systems

were defined prior to the Meaningful

Use objectives. Although a fully

functional system includes more features

than a basic system, it does not include

all of the features required for

Meaningful Use objectives. Therefore,

having a system that meets the criteria
Page 8 National Health Statistics Reports n Number 75 n May 20, 2014

2012

Table C. Meaningful Use Stage 1 Core Set objectives and corresponding survey question: National Ambulatory Medical Care Survey,

Meaningful Use objective 2012 NAMCS1

Core Set Physician has computerized system for:

Computerized provider order entry for medications ................... Prescription order entry
 

Drug-drug and drug-allergy interaction checks ...................... Drug interactions or contradictions warnings
 

Generate and transmit permissible prescriptions electronically ............ Sending prescription orders electronically to the pharmacy
 

Record patient demographics ................................ Patient history and demographic information
 

Maintain up-to-date problem list of current and active diagnoses .......... Patient problem list
 

Maintain active medication list ................................ Clinical notes include a list of patient’s medications and allergies2
 

Maintain active allergy list .................................. Clinical notes include a list of patient’s medications and allergies2
 

Vital signs ............................................ Recording and charting vital signs3
 

Smoking status ......................................... Recording patient smoking status3
 

Implement one clinical decision support rule and the ability to track Reminders for guideline-based interventions or screening tests AND
 

compliance with rule..................................... warnings of drug interactions or contradictions provided
 

Calculate and transmit CMS quality measure ...................... Reporting clinical quality measures to federal or state agencies
 

(such as CMS or Medicaid)3
 

Electronic copy of health information............................ Providing patients with an electronic copy of their health information3
 

Clinical summaries ....................................... Providing patients with clinical summaries for each visit4
 

Exchange key clinical information.............................. . . . 
 

Privacy or security ....................................... . . . 
 

. . . Data not available. 1In 2012, 19.5% of physicians had EHR systems able to meet 13 of 15 Stage 1 Core Set objectives. Physicians with fully functional systems were able to meet Stage 1 Core Set objectives more
 

frequently (54.9%) than physicians with basic systems (37.5%) and physicians using any type of EHR (26.8%) (p < 0.05).
 2List of patient’s medications and allergies collected separately in 2010 and 2011.
 3Available only in 2012.
 4Available only in 2011 and 2012.
 

NOTE: NAMCS is National Ambulatory Medical Care Survey. CMS is Centers for Medicare & Medicaid Services. EHR is electronic health record.

of a fully functional system does not

necessarily mean the system would meet

Meaningful Use objectives. In 2012,

about 72% of office-based physicians

used any type of EHR system, 39.6%

had a system that met the criteria of a

basic system, and 23.5% had a system

that met the criteria of a fully functional

system. In the same year, 19.5% of

physicians had computerized systems

ready to support 13 of 15 Meaningful

Use Stage 1 Core Set objectives. A

higher percentage of physicians with

fully functional systems had

computerized systems ready to meet

Stage 1 Core Set objectives (54.9%)

than physicians with basic systems

(37.5%) and physicians using any type

of EHR system (26.8%).

In 2012, adoption of an EHR

system varied by physician and practice

characteristics. Characteristics associated

with adoption were generally similar

regardless of whether physicians

adopted any type of EHR system, a

basic system, or a fully functional

system. Adoption was higher among

younger physicians compared with older

physicians; among primary care

physicians compared with nonprimary

care physicians; among physicians in

large practices compared with those in

smaller practices; among physicians in

multispecialty practices compared with

those in single-specialty practices, and

among physicians in HMO-owned

practices compared with those in

physician-owned practices.

During 2007–2012, use of any type

of EHR system and adoption of a basic

system both increased in all categories

of physician specialty and practice size.

Due to different rates of increase by

specialty and practice size, primary care

physicians started to have a higher use

of any EHR system and adoption of a

basic system than nonprimary care

physicians in 2010. A widened gap in

adoption of fully functional systems by

practice size (practices with 11 or more

physicians compared with solo

practitioners) and by specialty (primary

care compared with nonprimary care)

was observed starting in 2008 and 2009,

respectively. On the other hand, gaps in

the use of any type of EHR system

narrowed between physicians in

practices with 11 or more physicians

and all smaller practices between 2007

and 2012.

In conclusion, adoption and use of

EHR systems continues. However, only

two-fifths of physicians had adopted a

basic system by 2012, and less than

one-quarter had adopted a fully

functional system. The list of features

for these two types of EHR systems

overlaps with some but not all of the

features of an EHR system that are

needed to demonstrate meaningful use.

A previous report found that of the

65.5% of physicians intending to

participate in the Medicare and

Medicaid Incentive Programs in 2012,

only 26.9% had an EHR system with

features that could support 13 of 15

Stage 1 Meaningful Use Core Set

objectives (8). These estimates translate

into an estimated 18% of physicians

who may be eligible for Meaningful Use

incentives. However, this is a maximum

estimate because some physicians

counted in this measure may have an

EHR system that does not support the

remaining requirements necessary for

payment. More generally, rates of EHR

adoption continue to vary based on

certain physician and practice

characteristics, such as practice size and

physician specialty.
National Health Statistics Reports

n Number 75n May 20, 2014	 Page9

References

1.	 Blumenthal D, Tavenner M. The

‘‘meaningful use’’ regulation for

electronic health records.N EnglJ

Med 363(6):501–4. 2010.

2.	 Maxson E, Jain S, Kendall M,

Mostashari F, Blumenthal D. The

regional extension center program:

Helping physicians meaningfully use

health information technology. Ann

Intern Med 153(10):666–70. 2010.

3.	 Robert Wood Johnson Foundation.

Health information technology in the

United States: Where we stand, 2008.

2008.

4.	 Burt CW, Hing E. Use of

computerized clinical support

systems in medical settings: United

States, 2001–03. Advance data from

vital and health statistics; no 353.

Hyattsville, MD: National Center for

Health Statistics. 2005.

5.	 Burt CW, Hing E, Woodwell D.

Electronic medical record use by

office-based physicians: United

States, 2005. Health E-stat. National

Center for Health Statistics. 2006.

6.	 Burt CW, Sisk JE. Which physicians

and practices are using electronic

medical records? Health

Aff (Millwood) 24(5):1334–43. 2005.

7.	 Hing E, Burt CW, Woodwell DA.

Electronic medical record use by

office-based physicians and their

practices: United States, 2006.

Advance data from vital and health

statistics; no 393. Hyattsville, MD:

National Center for Health Statistics.

2007.

8.	 Hsiao CJ, Hing E. Use and

characteristics of electronic health

record systems among office-based

physician practices: United States,

2001–2012. NCHS data brief, no

111. Hyattsville, MD: National

Center for Health Statistics. 2012.

9.	 Hsiao CJ, Hing E, Socey TC, Cai B.

Electronic medical record/electronic

health record systems of office-based

physicians: United States, 2009 and

preliminary 2010 state estimates.

Health E-stat. National Center for

Health Statistics. 2010.

10. Hsiao CJ, Hing E, Socey TC, Cai B.

Electronic health record systems and

intent to apply for meaningful use

incentives among office-based

physician practices: United States,

2001–2011. NCHS data brief, no 79.

Hyattsville, MD: National Center for

Health Statistics. 2011.

11. Hsiao CJ, Decker SL, Hing E, Sisk

JE. Most physicians were eligible for

federal incentives in 2011, but few

had EHR systems that met

meaningful-use criteria. Health

Aff (Millwood) 31(5):1100–7. 2012.

12. RTI International. SUDAAN (Release

9.0) [computer software]. 2004.

13. Sirkem MG, Shimizu I, French DK,

Brock DB. Manual on standards and

procedures for reviewing statistical

reports. Hyattsville, MD: National

Center for Health Statistics. 1990.

14. McClellan SR, Casalino LP, Shortell

SM, Rittenhouse DR. When does

adoption of health information

technology by physician practices

lead to use by physicians within the

practice?J Am Med Inform Assoc

20(e1):e26–32. 2013.

15. Fleming NS, Culler SD, McCorkle

R, Becker ER, Ballard DJ. The

financial and nonfinancial costs of

implementing electronic health

records in primary care practices.

Health Aff (Millwood) 30(3):481–9.

2011.

16. Department of Health and Human

Services, Centers for Medicare&

Medicaid Services. Medicare and

Medicaid Programs; electronic health

record incentive program. Final rule.

Fed Regist 75(144):44314–588. 2010.
Page 10 National Health Statistics Reports n Number 75 n May 20, 2014

Table 1. Percent distribution of office-based physicians: United States, 2007–2012

2007 2008 2009 2010 2011 2012 Percent

percent percent percent percent percent percent change between

distribution distribution distribution distribution distribution distribution 2007 and 2012

Physician or practice characteristic (SE)1 (SE)1 (SE)1 (SE)1 (SE)1 (SE)1 percentages2

Age of physician

Under 35 years3 ..................... 8.2 (0.9) 2.8 (0.5) 3.3 (0.5) 3.1 (0.4) 2.6 (0.4) 2.5 (0.3) –69.5

35–44 years3 ....................... 28.1 (1.4) 26.9 (1.8) 23.7 (0.9) 22.8 (0.8) 23.0 (1.0) 22.7 (1.0) –19.2

45–54 years........................ 35.0 (1.5) 34.6 (1.8) 31.9 (1.1) 32.4 (0.9) 28.3 (1.1) 31.5 (1.1) –10.0

55–64 years3 ....................... 20.0 (1.1) 24.2 (1.4) 29.7 (1.0) 28.7 (0.9) 32.1 (1.2) 30.0 (1.1) 50.0

65 years and over3 ................... 8.5 (0.9) 11.2 (0.9) 11.2 (0.7) 12.9 (0.7) 14.0 (0.9) 13.2 (0.8) 55.3

Unknown ......................... * (. . .) *0.4 (0.1) *0.2 (0.1) *0.1 (0.1) – (. . .) – (. . .) . . .

Physician specialty type4

Primary care ....................... 49.8 (1.0) 50.9 (1.8) 50.7 (1.0) 49.4 (0.9) 47.3 (1.2) 48.5 (1.2) –2.6

Surgical .......................... 22.2 (0.9) 20.2 (1.0) 20.4 (0.7) 21.4 (0.7) 20.7 (1.0) 22.5 (1.0) 1.4

Medical .......................... 28.1 (1.0) 28.8 (2.1) 28.9 (0.9) 29.3 (0.8) 31.9 (1.2) 29.1 (1.1) 3.6

Physician sex

Female3 .......................... 25.3 (1.3) 25.0 (1.4) 26.3 (1.0) 26.5 (0.8) 26.7 (1.1) 30.3 (1.1) 19.8

Male3 ............................ 74.7 (1.3) 74.8 (1.4) 73.7 (1.0) 73.5 (0.8) 73.3 (1.1) 69.7 (1.1) –6.7

Unknown ......................... – (. . .) *0.1 (0.1) – (. . .) – (. . .) – (. . .) – (. . .) . . .

Practice size (number of physicians)5

Solo............................. 30.7 (1.6) 30.7 (1.7) 30.6 (1.1) 32.0 (1.0) 28.4 (1.2) 28.8 (1.1) –6.2

Partner3 .......................... 12.3 (1.0) 14.1 (1.8) 11.2 (0.7) 10.5 (0.7) 10.2 (0.7) 9.3 (0.7) –24.4

3–53 ............................ 29.9 (1.5) 27.6 (2.0) 25.3 (1.3) 26.1 (0.9) 26.4 (1.0) 24.6 (1.0) –17.7

6–10 ............................ 16.4 (1.2) 16.3 (1.1) 18.6 (1.0) 17.8 (0.7) 18.2 (0.9) 17.7 (0.9) 7.9

11 or more3 ........................ 10.6 (1.2) 11.3 (1.2) 14.1 (1.2) 13.6 (0.7) 16.8 (0.9) 19.5 (0.9) 84.0

Breadth of specialization5

Single-specialty3 ..................... 79.0 (1.5) 79.6 (1.5) 76.8 (1.2) 78.0 (0.8) 75.6 (1.1) 73.9 (1.0) –6.5

Multispecialty3 ...................... 20.6 (1.5) 20.2 (1.5) 22.3 (1.1) 21.6 (0.8) 24.4 (1.1) 26.1 (1.0) 26.7

Unknown ......................... 0.4 (0.2) *0.2 (0.1) 0.9 (0.2) 0.3 (0.1) – (. . .) – (. . .) . . .

Practice ownership5,6

Physician or physician group3 ............. 80.6 (1.4) 79.1 (1.6) 77.3 (1.1) 75.2 (0.9) 62.7 (1.2) 63.1 (1.1) –21.7

HMO ............................ 2.9 (0.5) 3.1 (0.9) 2.2 (0.3) 2.1 (0.3) 3.0 (0.5) 2.8 (0.5) –3.4

Community health center................ 3.5 (0.6) 3.2 (0.4) 4.4 (0.7) 3.5 (0.4) 3.7 (0.4) 3.4 (0.4) –2.9

Other3,7 .......................... 12.1 (1.1) 13.7 (1.3) 15.2 (1.0) 18.6 (0.9) 29.2 (1.1) 29.1 (1.0) 140.5

Unknown ......................... * (. . .) *0.9 (0.5) 0.9 (0.3) 0.6 (0.1) 1.3 (0.4) 1.5 (0.3) . . .

Percentage revenue from Medicaid

Less than 5%3 ...................... 36.8 (1.9) 34.9 (2.0) 33.9 (1.2) 35.3 (1.0) 31.5 (1.2) 30.8 (1.1) –16.3

5%–19% .......................... 29.7 (1.9) 31.9 (2.1) 30.5 (1.2) 29.1 (0.9) 27.5 (1.0) 27.9 (1.0) –6.1

20% or more ....................... 22.1 (1.6) 22.3 (1.7) 22.5 (1.1) 23.8 (0.9) 26.0 (1.0) 25.6 (1.0) 15.8

Unknown3 ......................... 11.3 (1.0) 10.9 (0.9) 13.1 (0.8) 11.8 (0.6) 14.9 (0.9) 15.7 (0.9) 38.9

Geographic region

Northeast ......................... 20.1 (1.4) 19.7 (1.3) 21.1 (1.1) 20.7 (0.8) 20.9 (0.3) 22.2 (0.2) 10.4

Midwest .......................... 21.2 (1.4) 21.9 (1.7) 20.4 (1.1) 19.8 (0.9) 20.9 (0.3) 21.2 (0.3) 0.0

South............................ 36.4 (1.6) 36.3 (2.2) 34.3 (1.4) 34.9 (0.9) 35.9 (0.3) 34.2 (0.2) –6.0

West ............................ 22.3 (1.0) 22.0 (1.2) 24.2 (1.2) 24.5 (0.7) 22.4 (0.4) 22.4 (0.3) 0.4

Metropolitan status

Metropolitan statistical area .............. 87.8 (1.8) 90.4 (1.6) 89.6 (1.4) 89.4 (0.9) 88.6 (0.5) 89.2 (0.5) 1.6

Not a metropolitan statistical area .......... 12.2 (1.8) 9.6 (1.6) 10.4 (1.4) 10.6 (0.9) 11.4 (0.5) 10.8 (0.5) –11.5

* Figure does not meet standards of reliability or precision.

. . . Category not applicable.

– Quantity zero. 1Based on 1,743 physicians in 2007, 2,338 physicians in 2008, 2,646 physicians in 2009, 6,121 physicians in 2010, 4,326 physicians in 2011, and 4,545 physicians in 2012. Data include
 

nonfederal office-based physicians who see patients in an office setting and exclude radiologists, anesthesiologists, and pathologists.
 2Differences tested only if both estimates were reliable.
 3Significant difference between 2007 and 2012 (p < 0.05).
 4Primary care includes family practice, pediatrics, obstetrics and gynecology, and internal medicine. Surgical includes all surgical specialties such as urology, plastic surgery, and abdominal
 

surgery. Medical includes all nonsurgical medical specialties such as dermatology, cardiovascular disease, and neurology. For the complete list of all physician specialties and specialty types, see
 

the public-use data file documentation available from: ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Dataset_Documentation/NAMCS/doc2010.pdf.
 5Practice size and breadth of specialization were associated with the location where the physician saw the most ambulatory care patients. These variables may not accurately reflect practice size
 

and breadth if the sampled location is different from other locations.
 6Self-reported by physicians.
 7Includes medical or academic health center, other hospital, other health care corporation, and other.
 

NOTES: SE is standard error. HMO is health maintenance organization. Estimates based on fewer than 30 cases in the sample data are not presented and are represented by an asterisk (*).
 

Estimates based on 30 or more cases include an asterisk (*) if the relative standard error of the estimate exceeds 30%.
 
National Health Statistics Reports n Number 75 n May 20, 2014 Page 11

Table 2. Percentage of office-based physicians using any type of electronic medical record or electronic health record system:

United States, 2007–2012

Percent change

2007 2008 2009 2010 2011 2012 between

percent percent percent percent percent percent 2007 and 2012

Physician or practice characteristic (SE)1 (SE)1 (SE)1 (SE)1 (SE)1 (SE)1 percentages2

All physicians .................... 34.8 (1.6) 42.0 (1.9) 48.3 (1.3) 51.0 (1.1) 57.0 (1.2) 71.8 (1.0) 106.3

Age of physician

Under 35 years ................... 47.9 (6.4) 61.7 (8.4) 65.3 (6.8) 68.7 (5.1) 78.5 (5.1) 83.8 (5.7) 74.9

35–44 years ..................... 41.1 (2.9) 51.9 (4.0) 56.4 (2.6) 62.3 (1.9) 69.6 (2.3) 81.1 (1.7) 97.3

45–54 years ..................... 34.0 (2.4) 39.5 (3.4) 53.7 (2.1) 54.5 (1.9) 60.2 (2.2) 76.5 (1.7) 125.0

55–64 years ..................... 28.7 (2.6) 37.8 (3.1) 42.3 (2.2) 45.0 (1.9) 49.8 (2.2) 66.8 (2.1) 132.8

65 years and over ................. 19.3 (4.5) 28.9 (3.5) 25.9 (2.7) 31.2 (2.6) 42.6 (3.5) 53.6 (3.3) 177.7

Unknown ....................... * (. . .) 80.2 (11.9) 93.6 (6.9) * (. . .) – (. . .) – (. . .) . . .

Physician specialty type3

Primary care ..................... 34.7 (2.2) 43.3 (2.2) 49.4 (1.9) 54.1 (1.4) 61.2 (1.6) 74.9 (1.4) 115.9

Nonprimary care .................. 34.9 (2.4) 40.6 (3.3) 47.1 (1.7) 48.0 (1.4) 53.3 (1.8) 68.8 (1.5) 97.1

Surgical ...................... 36.5 (3.0) 46.4 (2.7) 47.4 (2.1) 47.6 (2.1) 53.1 (2.7) 66.5 (2.4) 82.2

Medical....................... 33.7 (2.9) 36.6 (4.8) 46.8 (2.3) 48.2 (1.9) 53.4 (2.4) 70.7 (2.0) 109.8

Physician sex

Female ........................ 36.1 (2.7) 44.3 (3.1) 48.9 (2.3) 53.2 (1.8) 62.0 (2.2) 76.2 (1.7) 111.1

Male .......................... 34.4 (1.8) 41.1 (2.2) 48.1 (1.5) 50.2 (1.3) 55.2 (1.5) 69.8 (1.3) 102.9

Unknown ....................... – (. . .) * (. . .) – (. . .) – (. . .) – (. . .) – (. . .) . . .

Practice size (number of physicians)4

Solo .......................... 20.6 (2.3) 33.1 (3.1) 30.3 (1.8) 29.9 (1.7) 29.9 (2.1) 54.5 (2.3) 164.6

Partner ........................ 27.4 (4.0) 30.2 (5.2) 41.3 (3.2) 43.6 (3.2) 58.0 (3.7) 70.1 (3.3) 155.8

3–5. . . . . . . . . . . . . . . . . . . . . . . . . . . 31.8 (3.1) 37.8 (3.1) 51.1 (2.3) 55.3 (1.9) 60.5 (2.2) 71.9 (2.0) 126.1

6–10 .......................... 47.0 (4.1) 50.7 (3.7) 54.9 (2.9) 64.4 (2.1) 68.0 (2.5) 80.9 (2.0) 72.1

11 or more ...................... 74.3 (4.2) 78.4 (3.4) 79.1 (2.6) 80.3 (2.1) 85.0 (2.0) 89.5 (1.6) 20.5

Breadth of specialization4

Single-specialty ................... 30.3 (1.4) 36.8 (2.0) 42.8 (1.4) 44.8 (1.2) 49.5 (1.4) 66.5 (1.3) 119.5

Multispecialty..................... 52.5 (4.0) 62.2 (3.2) 67.6 (2.8) 73.4 (2.0) 80.2 (1.9) 86.8 (1.5) 65.3

Unknown ....................... * (. . .) 74.1 (15.8) * (. . .) * (. . .) – (. . .) – (. . .) . . .

Practice ownership4,5

Physician or physician group ........... 31.4 (1.8) 37.1 (1.9) 43.5 (1.4) 45.8 (1.3) 50.0 (1.5) 66.5 (1.4) 111.8

HMO.......................... 86.1 (6.6) 92.4 (3.7) 96.2 (3.3) 96.0 (2.6) 99.6 (0.3) 97.2 (1.7) 12.9

Community health center ............. 40.0 (8.3) 54.3 (7.9) 59.6 (8.3) 60.7 (6.4) 77.4 (4.3) 81.0 (6.0) 102.5

Other6 ......................... 46.3 (4.5) 57.9 (4.7) 62.2 (3.1) 65.4 (2.1) 66.2 (1.9) 80.0 (1.7) 72.8

Unknown ....................... – (. . .) * (. . .) 51.2 (14.0) 43.4 (10.4) *33.5 (10.1) 64.1 (9.6) . . .

Percentage revenue from Medicaid

Less than 5% .................... 32.6 (3.1) 40.4 (3.1) 43.7 (2.2) 47.3 (1.8) 45.4 (2.3) 64.9 (2.1) 99.1

5%–19% ....................... 34.3 (3.0) 42.8 (3.6) 48.5 (2.3) 53.3 (2.1) 59.5 (2.1) 73.7 (1.7) 114.9

20% or more ..................... 34.7 (3.4) 41.4 (4.1) 48.9 (3.1) 47.6 (2.1) 60.7 (2.2) 71.9 (1.9) 107.2

Unknown ....................... 43.4 (4.3) 46.1 (4.8) 58.4 (3.1) 63.1 (2.4) 70.9 (3.1) 81.5 (2.3) 87.8

Geographic region

Northeast ....................... 24.2 (3.3) 41.0 (3.1) 44.9 (2.7) 48.8 (2.3) 54.5 (2.7) 70.2 (2.3) 190.1

Midwest ........................ 35.6 (3.2) 43.8 (4.7) 44.9 (2.6) 55.9 (1.9) 60.5 (2.1) 71.0 (1.8) 99.4

South ......................... 35.1 (2.5) 37.5 (3.3) 45.9 (2.3) 47.4 (1.9) 52.6 (1.8) 68.6 (1.7) 95.4

West .......................... 43.1 (3.9) 48.5 (3.1) 57.4 (2.8) 54.1 (2.5) 63.4 (3.4) 78.9 (2.5) 83.1

Metropolitan status

Metropolitan statistical area ............ 35.0 (1.9) 41.6 (1.9) 49.0 (1.3) 50.8 (1.2) 56.4 (1.3) 72.0 (1.1) 105.7

Not a metropolitan statistical area ........ 33.5 (5.8) 45.8 (7.4) 41.8 (4.6) 52.7 (3.1) 61.7 (2.4) 69.5 (2.3) 107.5

* Figure does not meet standards of reliability or precision.
 

. . . Category not applicable.
 

– Quantity zero.
 1Based on 1,743 physicians in 2007, 2,338 physicians in 2008, 2,646 physicians in 2009, 6,121 physicians in 2010, 4,326 physicians in 2011, and 4,545 physicians in 2012. Data include
 

nonfederal office-based physicians who see patients in an office setting and exclude radiologists, anesthesiologists, and pathologists.
 2Differences tested only if both estimates were reliable. All available differences between 2007 and 2012 are significant (p < 0.05), except for HMO ownership.
 
Page 12 National Health Statistics Reports n Number 75 n May 20, 2014

3Primary care includes family practice, pediatrics, obstetrics and gynecology, and internal medicine. Surgical includes all surgical specialties such as urology, plastic surgery, and abdominal
 

surgery. Medical includes all other nonsurgical medical specialties such as dermatology, cardiovascular disease, and neurology. For the complete list of all physician specialties and specialty types,
 

see the public-use data file documentation available from: ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Dataset_Documentation/NAMCS/doc2010.pdf.
 4Practice size and breadth of specialization were associated with the location where the physician saw the most ambulatory care patients. These variables may not accurately reflect practice size
 

and breadth if the sampled location is different from other locations.
 5Self-reported by physicians.
 6Includes medical or academic health center, other hospital, other health care corporation, and other.
 

NOTES: SE is standard error. HMO is health maintenance organization. Estimates based on fewer than 30 cases in the sample data are not presented and are represented by an asterisk (*).
 

Estimates based on 30 or more cases include an asterisk (*) if the relative standard error of the estimate exceeds 30%.
 
National Health Statistics Reports n Number 75 n May 20, 2014 Page 13

Table 3. Percentage of office-based physicians with a basic system: United States, 2007–2012

Percent change

2007 2008 2009 2010 2011 2012 between 2007

percent percent percent percent percent percent and 2012

Physician or practice characteristic (SE)1 (SE)1 (SE)1 (SE)1 (SE)1 (SE)1 percentages2

All physicians ....................... 11.8 (1.1) 16.9 (1.3) 21.8 (1.2) 27.9 (1.0) 33.9 (1.2) 39.6 (1.1) 235.6

Age of physician

Under 35 years...................... 18.8 (4.1) 24.6 (10.3) 41.0 (9.2) 44.0 (5.8) 52.8 (7.2) 46.3 (5.9) 146.3

35–44 years........................ 17.9 (2.5) 24.9 (2.9) 24.3 (2.1) 33.9 (1.9) 41.6 (2.5) 45.2 (2.4) 152.5

45–54 years........................ 9.0 (1.2) 12.7 (1.6) 24.6 (1.7) 30.3 (1.7) 35.6 (2.1) 42.8 (2.0) 375.6

55–64 years........................ 8.1 (1.7) 17.0 (2.6) 17.8 (1.5) 24.3 (1.6) 29.8 (2.1) 35.9 (2.1) 343.2

65 years and over .................... 5.2 (2.1) 8.0 (1.8) 13.7 (2.3) 15.7 (2.2) 23.9 (3.0) 29.3 (2.9) 463.5

Unknown ......................... – (. . .) * (. . .) * (. . .) – (. . .) – (. . .) – (. . .) . . .

Physician specialty type3

Primary care ....................... 14.5 (1.6) 18.8 (1.8) 23.8 (1.8) 32.5 (1.4) 39.0 (1.6) 43.7 (1.6) 201.4

Nonprimary care ..................... 9.0 (1.2) 15.1 (1.9) 19.7 (1.3) 23.6 (1.3) 29.3 (1.6) 35.7 (1.6) 296.7

Surgical ......................... 10.7 (1.6) 19.0 (2.8) 19.3 (1.5) 22.5 (1.7) 29.3 (2.4) 33.9 (2.4) 216.8

Medical ......................... 7.7 (1.4) 12.3 (1.8) 20.0 (1.8) 24.3 (1.7) 29.3 (2.2) 37.1 (2.2) 381.8

Physician sex

Female........................... 15.7 (2.1) 17.8 (2.8) 19.4 (2.1) 28.9 (1.6) 35.4 (2.2) 45.9 (2.1) 192.4

Male ............................ 10.5 (1.1) 16.5 (1.4) 22.6 (1.3) 27.6 (1.2) 33.4 (1.4) 36.8 (1.3) 250.5

Unknown ......................... – (. . .) * (. . .) – (. . .) – (. . .) – (. . .) – (. . .) . . .

Practice size (number of physicians)4

Solo............................. 5.2 (1.0) 7.5 (1.2) 10.3 (1.4) 13.1 (1.4) 14.9 (1.8) 22.9 (1.9) 340.4

Partner........................... 10.3 (2.5) 16.3 (4.2) 15.8 (2.5) 24.4 (2.9) 32.7 (3.6) 30.5 (3.4) 196.1

3–5 ............................. 9.5 (1.7) 13.7 (1.6) 22.1 (2.1) 30.7 (1.7) 35.5 (2.2) 40.8 (2.2) 329.5

6–10 ............................ 15.3 (2.4) 22.7 (3.4) 25.3 (2.2) 36.1 (2.2) 39.1 (2.6) 44.9 (2.7) 193.5

11 or more ........................ 33.6 (5.8) 43.0 (4.6) 46.2 (3.9) 49.5 (2.6) 58.6 (3.0) 62.1 (2.5) 84.8

Breadth of specialization4

Single-specialty ..................... 9.7 (1.0) 12.9 (1.2) 17.6 (1.1) 22.6 (1.1) 26.8 (1.2) 31.9 (1.2) 228.9

Multispecialty ....................... 19.9 (3.7) 32.8 (3.4) 36.5 (3.1) 47.0 (2.2) 55.9 (2.5) 61.2 (2.2) 207.5

Unknown ......................... – (. . .) * (. . .) * (. . .) * (. . .) – (. . .) – (. . .) . . .

Practice ownership4,5

Physician or physician group ............. 8.8 (1.0) 12.8 (0.9) 18.0 (1.1) 23.9 (1.2) 26.9 (1.4) 32.5 (1.3) 269.3

HMO ............................ 49.0 (9.1) 68.3 (8.2) 71.7 (7.2) 84.5 (4.7) 96.2 (2.3) 88.5 (5.3) 80.6

Community health center................ *21.6 (8.7) *19.0 (6.2) *27.1 (9.6) 31.3 (6.2) 31.2 (5.9) 40.4 (6.3) . . .

Other6 ........................... 20.6 (4.2) 28.8 (4.5) 32.4 (3.1) 37.0 (2.1) 43.5 (2.1) 50.6 (2.0) 145.6

Unknown ......................... – (. . .) * (. . .) * (. . .) 33.1 (9.9) *19.5 (7.1) *30.9 (11.1) . . .

Percentage revenue from Medicaid

Less than 5%....................... 11.5 (1.6) 14.3 (1.7) 18.9 (1.8) 25.6 (1.8) 23.5 (2.0) 30.0 (2.1) 160.9

5%–19% .......................... 11.8 (1.6) 18.7 (2.6) 21.7 (1.6) 28.4 (1.8) 37.9 (2.0) 45.1 (2.0) 282.2

20% or more ....................... 10.6 (2.8) 15.7 (3.0) 24.0 (2.8) 26.7 (1.7) 35.6 (2.3) 38.8 (2.0) 266.0

Unknown ......................... 16.0 (3.0) 23.0 (4.2) 25.7 (2.8) 36.1 (2.5) 45.5 (3.3) 49.9 (3.3) 211.9

Geographic region

Northeast ......................... 5.6 (1.5) 15.7 (2.2) 16.6 (2.2) 23.4 (1.8) 30.4 (2.5) 40.1 (2.5) 616.1

Midwest .......................... 14.0 (2.6) 17.6 (2.9) 21.1 (1.9) 30.7 (1.8) 37.7 (2.0) 44.6 (1.9) 218.6

South............................ 11.2 (1.9) 13.3 (1.9) 19.1 (1.7) 24.0 (1.8) 29.0 (1.6) 35.7 (1.7) 218.8

West ............................ 16.1 (2.6) 23.4 (3.6) 30.7 (3.3) 35.2 (2.3) 41.5 (3.4) 40.1 (3.1) 149.1

Metropolitan status

Metropolitan statistical area .............. 11.9 (1.1) 16.6 (1.3) 21.9 (1.2) 27.6 (1.1) 33.4 (1.3) 39.5 (1.2) 231.9

Not a metropolitan statistical area .......... *11.1 (5.0) *20.2 (6.4) 20.6 (2.9) 30.8 (2.8) 37.6 (2.5) 40.3 (2.5) . . .

– Quantity zero.

. . . Category not applicable.

* Figure does not meet standards of reliability or precision. 1Based on 1,743 physicians in 2007, 2,338 physicians in 2008, 2,646 physicians in 2009, 6,121 physicians in 2010, 4,326 physicians in 2011, and 4,545 physicians in 2012. Data include
 

nonfederal office-based physicians who see patients in an office setting and exclude radiologists, anesthesiologists, and pathologists.
 2Differences tested only if both estimates were reliable. All available differences between 2007 and 2012 are significant (p < 0.05).
 3Primary care includes family practice, pediatrics, obstetrics and gynecology, and internal medicine. Surgical includes all surgical specialties such as urology, plastic surgery, and abdominal
 

surgery. Medical includes all nonsurgical medical specialties such as dermatology, cardiovascular disease, and neurology. For the complete list of all physician specialties and specialty types, see

the public-use data file documentation available from: ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Dataset_Documentation/NAMCS/doc2010.pdf.
Page 14 National Health Statistics Reports n Number 75 n May 20, 2014

4Practice size and breadth of specialization were associated with the location where the physician saw the most ambulatory care patients. These variables may not accurately reflect practice size
 

and breadth if the sampled location is different from other locations.
 5Self-reported by physicians.
 6Other ownership includes medical or academic health center, other hospital, other health care corporation, and other.
 

NOTES: SE is standard error. HMO is health maintenance organization. Basic systems through 2009 included six features (recording patient history and demographic information, clinical notes,
 

and patient problem lists; viewing laboratory and imaging results; and ordering prescriptions). In 2010, basic systems included one additional feature, a medications list, and for 2011–2012, a
 

medications and allergies list. Estimates based on fewer than 30 cases in the sample data are not presented and are represented by an asterisk (*). Estimates based on 30 or more cases include
 

an asterisk (*) if the relative standard error of the estimate exceeds 30%.
 
National Health Statistics Reports n Number 75 n May 20, 2014 Page 15

Table 4. Percentage of office-based physicians with a fully functional system: United States, 2007–2012

Percent change

2007 2008 2009 2010 2011 2012 between 2007

percent percent percent percent percent percent and 2012

Physician or practice characteristic (SE)1 (SE)1 (SE)1 (SE)1 (SE)1 (SE)1 percentages2

All physicians ....................... 3.8 (0.6) 4.5 (0.6) 6.9 (0.7) 13.2 (0.7) 16.7 (0.9) 23.5 (1.0) 518.4

Age of physician

Under 35 years...................... *5.8 (2.4) *20.5 (10.5) *6.7 (3.0) 16.9 (4.4) 28.2 (7.2) 24.8 (4.7) . . .

35–44 years........................ 6.2 (1.6) 5.9 (1.1) 8.5 (1.4) 17.4 (1.5) 21.7 (2.1) 26.5 (2.2) 327.4

45–54 years........................ 3.5 (0.8) 3.1 (0.7) 7.9 (1.2) 15.0 (1.3) 14.7 (1.5) 25.6 (1.8) 631.4

55–64 years........................ *1.3 (0.6) 4.6 (0.9) 5.7 (1.0) 11.3 (1.2) 15.9 (1.7) 22.8 (1.9) . . .

65 years and over .................... *0.6 (0.6) *1.0 (0.6) *4.4 (1.4) 4.4 (1.2) 12.2 (2.3) 14.7 (2.3) . . .

Unknown ......................... * (. . .) – (. . .) – (. . .) – (. . .) – (. . .) – (. . .) . . .

Physician specialty type3

Primary care ....................... 4.7 (1.0) 5.5 (1.0) 8.4 (1.0) 17.3 (1.2) 22.3 (1.4) 27.9 (1.4) 493.6

Nonprimary care ..................... 2.8 (0.7) 3.4 (0.7) 5.4 (0.7) 9.1 (0.8) 11.7 (1.2) 19.4 (1.4) 592.9

Surgical ......................... 3.9 (1.1) 4.3 (0.9) 5.6 (0.9) 7.7 (1.1) 11.5 (1.7) 15.4 (1.9) 294.9

Medical ......................... *1.9 (0.6) *2.8 (0.9) 5.3 (1.0) 10.2 (1.1) 11.8 (1.7) 22.5 (2.0) . . .

Physician sex

Female........................... 5.5 (0.7) 5.9 (1.7) 5.7 (1.0) 16.0 (1.4) 18.3 (1.8) 29.9 (2.0) 443.6

Male ............................ 3.2 (1.5) 4.0 (0.5) 7.4 (0.8) 12.2 (0.8) 16.2 (1.1) 20.7 (1.1) 546.9

Unknown ......................... – (. . .) * (. . .) – (. . .) – (. . .) – (. . .) – (. . .) . . .

Practice size (number of physicians)4

Solo............................. *1.6 (0.6) 2.1 (0.6) 3.0 (0.9) 4.8 (1.0) 5.5 (1.0) 11.9 (1.4) . . .

Partner........................... *4.0 (1.5) *3.3 (1.2) 5.5 (1.6) 9.8 (2.2) 15.7 (3.1) 18.3 (3.0) . . .

3–5 ............................. *2.5 (0.8) 2.5 (0.7) 6.0 (1.1) 15.1 (1.4) 19.2 (1.9) 23.9 (2.0) . . .

6–10 ............................ 4.5 (1.3) 5.3 (1.4) 9.2 (1.6) 17.7 (1.7) 17.6 (2.0) 23.5 (2.2) 422.2

11 or more ........................ *12.0 (4.1) 15.9 (3.7) 15.2 (2.3) 25.9 (2.6) 31.4 (2.9) 42.5 (2.7) . . .

Breadth of specialization4

Single-specialty ..................... 3.0 (0.5) 3.1 (0.6) 4.7 (0.5) 10.2 (0.7) 11.0 (0.8) 16.9 (1.0) 463.3

Multispecialty ....................... *6.8 (2.3) 9.8 (1.9) 15.0 (2.0) 24.0 (1.9) 34.6 (2.4) 42.2 (2.3) . . .

Unknown ......................... – (. . .) * (. . .) * (. . .) * (. . .) – (. . .) – (. . .) . . .

Practice ownership4,5

Physician or physician group ............. 2.7 (0.6) 3.5 (0.5) 5.2 (0.7) 10.2 (0.8) 12.4 (1.0) 17.4 (1.1) 544.4

HMO ............................ *27.1 (8.4) *27.7 (11.3) 53.4 (7.6) 78.7 (5.0) 89.1 (5.2) 80.6 (7.1) . . .

Community health center................ *1.9 (1.7) *8.0 (4.7) *5.2 (3.1) 18.5 (5.4) 16.1 (3.6) 26.4 (5.9) . . .

Other6 ........................... *5.9 (2.0) *4.4 (1.4) 9.2 (1.7) 16.9 (1.7) 19.0 (1.6) 31.0 (1.8) . . .

Unknown ......................... – (. . .) – (. . .) * (. . .) *9.8 (4.5) *10.1 (5.0) *17.9 (10.6) . . .

Percentage revenue from Medicaid

Less than 5%....................... *4.3 (1.3) 5.0 (1.2) 6.5 (1.2) 11.0 (1.1) 11.8 (1.5) 16.6 (1.7) . . .

5%–19% .......................... 3.2 (0.8) 2.4 (0.7) 7.5 (1.1) 12.5 (1.3) 18.9 (1.7) 28.8 (1.9) 800.0

20% or more ....................... *1.6 (0.7) 3.3 (0.9) 5.4 (1.1) 12.9 (1.3) 16.5 (1.6) 22.0 (1.7) . . .

Unknown ......................... 7.8 (1.9) *11.1 (3.5) 9.4 (1.8) 21.7 (2.3) 23.5 (2.9) 29.9 (3.1) 283.3

Geographic region

Northeast ......................... 1.6 (0.5) 4.3 (1.2) 3.9 (1.0) 11.8 (1.5) 12.4 (1.9) 21.4 (2.1) 1237.5

Midwest .......................... *3.2 (1.0) 4.1 (1.2) 5.9 (1.1) 14.6 (1.7) 20.0 (1.6) 30.0 (1.7) . . .

South............................ *3.3 (1.1) 2.8 (0.8) 5.4 (0.9) 10.3 (1.2) 13.0 (1.2) 18.3 (1.4) . . .

West ............................ 7.0 (2.0) 7.7 (1.9) 12.6 (2.0) 17.3 (1.5) 23.7 (2.8) 27.2 (2.9) 288.6

Metropolitan status

Metropolitan statistical area .............. 4.2 (0.7) 4.5 (0.7) 7.0 (0.7) 13.4 (0.8) 16.5 (1.0) 23.2 (1.1) 452.4

Not a metropolitan statistical area .......... *0.8 (0.6) *4.4 (2.2) 6.0 (1.4) 11.5 (1.4) 18.7 (2.1) 25.6 (2.3) . . .

* Figure does not meet standards of reliability or precision.

. . . Category not applicable.

– Quantity zero. 1Based on 1,743 physicians in 2007, 2,338 physicians in 2008, 2,646 physicians in 2009, 6,121 physicians in 2010, 4,326 physicians in 2011, and 4,545 physicians in 2012. Data include
 

nonfederal office-based physicians who see patients in an office setting and exclude radiologists, anesthesiologists, and pathologists.
 2Differences tested only if both estimates were reliable. All available differences between 2007 and 2012 are significant (p < 0.05).
 3Primary care includes family practice, pediatrics, obstetrics and gynecology, and internal medicine. Surgical includes all surgical specialties such as urology, plastic surgery, and abdominal
 

surgery. Medical includes all nonsurgical medical specialties such as dermatology, cardiovascular disease, and neurology. For the complete list of all physician specialties and specialty types, see

the public-use data file documentation available from: ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Dataset_Documentation/NAMCS/doc2010.pdf.
Page 16 National Health Statistics Reports n Number 75 n May 20, 2014

4Practice size and breadth of specialization were associated with the location where the physician saw the most ambulatory care patients. These variables may not accurately reflect practice size
 

and breadth if the sampled location is different from other locations.
 5Self-reported by physicians.
 6Other ownership includes medical or academic health center, other hospital, other health care corporation, and other.
 

NOTES: SE is standard error. HMO is health maintenance organization. Estimates based on fewer than 30 cases in the sample data are not presented and are represented by an asterisk (*).
 

Estimates based on 30 or more cases include an asterisk (*) if the relative standard error of the estimate exceeds 30%. Fully functional systems through 2009 included 14 features (patient history
 

and demographic information, clinical notes, and patient problem lists; viewing laboratory and imaging results; ordering prescriptions; medical history and follow-up notes; providing warnings for
 

drug interactions or contraindications; electronically sending prescriptions to the pharmacy; ordering laboratory tests; electronically sending test orders; providing reminders for guideline-based
 

interventions; providing out-of-range test levels; and having electronic images returned). Fully functional systems in 2010 did not include electronic images returned, but did include a medications
 

list. Fully functional systems for 2011 and 2012 did not include electronic images returned and out-of-range test levels, but did include a medications and allergies list.
 
National Health Statistics Reports n Number 75 n May 20, 2014 Page 17

Table 5. Percentage of office-based physicians reporting selected electronic medical record or electronic health record system features:

United States, 2007–2012

Percent

change

2007 2008 2009 2010 2011 2012 between 2007

percent percent percent percent percent percent and 2012

Features reported (SE)1 (SE)1 (SE)1 (SE)1 (SE)1 (SE)1 percentages2

Record patient history and demographic information.... 73.9 (1.8) 77.9 (1.7) 82.7 (1.0) 74.3 (0.9) 72.4 (1.1) 79.3 (1.0) 7.3

Patient problem lists ...................... 27.7 (1.5) 33.9 (1.6) 40.5 (1.3) 49.0 (1.1) 54.2 (1.2) 65.8 (1.1) 137.5

Order prescriptions ........................ 29.6 (1.5) 36.2 (1.8) 45.6 (1.2) 57.1 (1.0) 64.8 (1.2) 79.5 (0.9) 168.6

Warnings for drug interactions or contraindications . . . 18.8 (1.3) 26.2 (1.6) 34.8 (1.1) 43.6 (1.1) 50.8 (1.2) 66.5 (1.1) 253.7

Prescriptions sent to pharmacy electronically ....... 16.0 (1.2) 22.9 (1.5) 31.9 (1.1) 43.8 (1.1) 54.6 (1.2) 73.3 (1.0) 358.1

Order laboratory tests ...................... 28.5 (1.4) 30.6 (1.6) 38.4 (1.3) 48.5 (1.1) 51.0 (1.2) 62.5 (1.1) 119.3

Test orders sent electronically ................ 16.7 (1.2) 19.5 (1.4) 24.9 (1.1) 32.0 (1.0) 35.3 (1.2) 44.7 (1.2) 167.7

Provide standard order sets related to a particular

condition or procedure ..................... --­ (. . .) --­ (. . .) --­ (. . .) --­ (. . .) 36.3 (1.2) 46.6 (1.2) . . .

View laboratory results ...................... 44.8 (1.7) 52.3 (1.8) 58.3 (1.2) 62.5 (1.0) 67.4 (1.2) 72.9 (1.1) 62.7

Out-of-range values highlighted ............... 29.9 (1.7) 40.0 (1.9) 44.9 (1.3) 46.2 (1.1) - - ­ (. . .) - - ­ (. . .) . . .

Results incorporated into EMR/EHR ............ --­ (. . .) --­ (. . .) --­ (. . .) 42.2 (1.1) 44.6 (1.2) - - ­ (. . .) . . .

EMR/EHR automatically graphs patient’s laboratory

results over time........................ --­ (. . .) --­ (. . .) --­ (. . .) --­ (. . .) --­ (. . .) 42.7 (1.2) . . .

View imaging results ....................... 36.9 (1.6) 45.2 (1.9) 49.2 (1.3) 51.5 (1.1) 56.4 (1.2) 59.1 (1.2) 60.2

Electronic images returned .................. 16.7 (1.0) 23.0 (1.9) 24.8 (1.1) - - ­ (. . .) - - ­ (. . .) - - ­ (. . .) . . .

View data on quality of care measures ............ --­ (. . .) --­ (. . .) --­ (. . .) --­ (. . .) 30.2 (1.1) 42.8 (1.2) . . .

Record clinical notes ....................... 34.8 (1.4) 41.2 (1.7) 47.3 (1.4) 56.8 (1.0) 61.6 (1.2) 72.8 (1.0) 109.2

Medical history and follow-up notes ............ 26.9 (1.4) 35.0 (1.7) 42.0 (1.5) - - ­ (. . .) - - ­ (. . .) - - ­ (. . .) . . .

List of medications .......................

List of allergies (including allergies to medication) ....

- - ­

--­

(. . .)

(. . .)

--­

--­

(. . .)

(. . .)

--­

--­

(. . .)

(. . .)

49.7

48.8

(1.1)

(1.1)

3

56.5 (1.2) 368.3 (1.1) ...

. . .

Provide guideline-based interventions or screening test

reminders ............................. 25.9 (1.5) 29.5 (1.6) 34.0 (1.2) 37.9 (1.0) 40.0 (1.2) 50.2 (1.2) 93.8

Report to immunization registries electronically ....... --­ (. . .) --­ (. . .) --­ (. . .) 26.9 (1.1) 26.8 (1.1) 32.0 (1.1) . . .

Report in standards specified by Meaningful Use

criteria ............................... --­ (. . .) --­ (. . .) --­ (. . .) --­ (. . .) --­ (. . .) 19.2 (0.9) . . .

Public health reporting ...................... 13.8 (1.1) 13.1 (1.1) 13.8 (0.8) - - ­ (. . .) 12.1 (0.8) - - ­ (. . .) . . .

Notifiable diseases sent electronically ........... 6.1 (0.8) 4.8 (0.8) 5.2 (0.5) - - ­ (. . .) 4.5 (0.5) - - ­ (. . .) . . .

Provide patients with clinical summaries for each visit. . . - - ­ (. . .) - - ­ (. . .) - - ­ (. . .) - - ­ (. . .) 38.3 (1.2) 56.1 (1.2) . . .

Exchange secure message(s) with patients ......... --­ (. . .) --­ (. . .) --­ (. . .) --­ (. . .) 28.2 (1.1) 39.5 (1.1) . . .

Record and chart vital signs................... --­ (. . .) --­ (. . .) --­ (. . .) --­ (. . .) --­ (. . .) 68.6 (1.1) . . .

Record patient smoking status ................. --­ (. . .) --­ (. . .) --­ (. . .) --­ (. . .) --­ (. . .) 68.7 (1.1) . . .

Report clinical quality measures to federal or state

agencies .............................. --­ (. . .) --­ (. . .) --­ (. . .) --­ (. . .) --­ (. . .) 36.6 (1.1) . . .

Generate lists of patients with particular health

conditions ............................. --­ (. . .) --­ (. . .) --­ (. . .) --­ (. . .) --­ (. . .) 52.6 (1.2) . . .

Provide patients with an electronic copy of their health

information ............................ --­ (. . .) --­ (. . .) --­ (. . .) --­ (. . .) --­ (. . .) 51.1 (1.2) . . .

- - - Data not available.
 

. . . Category not applicable.
 1Based on 1,743 physicians in 2007, 2,338 physicians in 2008, 2,646 physicians in 2009, 6,121 physicians in 2010, 4,326 physicians in 2011, and 4,545 physicians in 2012. Data include
 

nonfederal office-based physicians who see patients in an office setting and exclude radiologists, anesthesiologists, and pathologists.
 2Differences tested only if both estimates were reliable. All available differences between 2007 and 2012 are significant (p < 0.05).
 3List of medications and allergies combined for 2011 and 2012.
 

NOTES: SE is standard error. EMR is electronic medical record. EHR is electronic health record. Specific features are reported as available even if they were turned off.
 
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For more NCHS NHSRs, visit:

http://www.cdc.gov/nchs/products/nhsr.htm.

National Health Statistics Reports n Number 75 n May 20, 2014

Suggested citation

Hsiao CJ, Hing E, Ashman J. Trends in

electronic health record system use among

office-based physicians: United States,

2007–2012. National health statistics reports;

no 75. Hyattsville, MD: National Center for

Health Statistics. 2014.

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., M.B.A., Director

Jennifer H. Madans, Ph.D., Associate Director

for Science

Division of Health Care Statistics

Clarice Brown, M.S., Director

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DHHS Publication No. 2014–1250 • CS247154