U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics

Adoption of Certified Electronic Health Record Systems and 

Electronic Information Sharing in Physician Offices:

 United States, 2013 and 2014

Eric W. Jamoom, Ph.D., M.P.H., M.S.; Ninee Yang, Ph.D.; and Esther Hing, M.P.H.

Key findings 

Data from the 2014 

National Electronic Health 

Records Survey

● In 2014, 74.1% of officebased physicians had a certified 

electronic health record (EHR) 

system, up from 67.5% in 2013.

● The percentage of physicians

who had a certified EHR 

system ranged from 58.8% in 

Alaska to 88.6% in Minnesota.

● In 2014, 32.5% of officebased physicians with a 

certified EHR system were 

electronically sharing patient 

health information with 

external providers.

● The percentage of physicians

with a certified EHR system 

electronically sharing patient 

health information with 

external providers ranged from 

17.7% in New Jersey to 58.8% 

in North Dakota.

The Health Information Technology for Economic and Clinical Health Act 

(HITECH) of 2009 provides incentive payments to eligible hospitals and 

providers that demonstrate the meaningful use of a certified electronic health 

record (EHR) system (1,2). In 2010, the Office of the National Coordinator for 

Health Information Technology began certifying EHR systems as having the 

capabilities that could enable meeting meaningful use criteria (2). This report 

uses the National Electronic Health Records Survey (NEHRS) to describe 

physician adoption of certified EHR systems from 2013 to 2014 across the 

United States and the extent to which physicians with certified EHR systems 

share patient health information.

Keywords: health information technology • National Ambulatory Medical 

Care Survey • National Electronic Health Records Survey 

Certified EHR systems in physician offices increased from 

2013 to 2014.

Figure 1. Office-based physicians with a certified electronic health record system, by physician 

specialty: United States, 2013–2014 

NCHS Data Brief ■ No. 236 ■ January 2016
NCHS Data Brief ■ No. 236 ■ January 2016

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● In 2014, 74.1% of office-based physicians reported having a certified EHR system, up from

67.5% in 2013 (Figure 1).

● The percentage of primary care physicians with certified EHR systems in 2013 (72.1%)

and 2014 (78.6%) exceeded that for nonprimary care specialists in both years (63.1% and

70.3%, respectively).

Adoption of certified EHR systems in office-based practices varied across 

states.

● In 2014, the percentage of physicians who had a certified EHR system ranged from 58.8%

in Alaska to 88.6% in Minnesota (Figure 2).

● The percentage of physicians who had a certified EHR system was less than the national

percentage (74.1%) in Alaska (58.8%) and greater than the national percentage in six states:

Iowa (83.4%), North Carolina (84.8%), Oregon (85.0%), Vermont (85.0%), South Dakota

(86.1%), and Minnesota (88.6%).

Figure 2. Percentage of office-based physicians who have a certified electronic health record system, by state:

United States, 2014

NOTES: Having a certified electronic health record system was defined by physicians answering “yes” to “Does your current system meet meaningful use 

criteria as defined by the Department of Health and Human Services?” Significance is tested at p < 0.05.

SOURCE: CDC/NCHS, National Electronic Health Records Survey, 2014.

 
NCHS Data Brief ■ No. 236 ■ January 2016

■  3  ■

About one-third of office-based physicians with a certified EHR system 

shared patient health information with ambulatory providers outside their 

practice or with unaffiliated hospitals.

● In 2014, more than one-third of physicians (39.1%) were electronically sharing patient 

health information with any ambulatory providers or hospitals. A larger percentage of 

physicians with a certified EHR system (47.8%) were electronically sharing patient health 

information with any ambulatory providers or hospitals compared with physicians who did 

not have a certified EHR system (29.7%) (calculated from Figure 3).

● In 2014, a larger percentage of physicians with a certified EHR system (32.5%) were 

electronically sharing patient health information with external providers or unaffiliated 

hospitals than were physicians who did not have a certified EHR system (16.8%) (Figure 3). 

● In 2014, a larger percentage of physicians who did not have a certified EHR system (70.3%) 

were not sharing patient health information with any ambulatory providers or hospitals 

compared with physicians with a certified EHR system (52.2%).

● For physicians that were only sharing with internal providers or affiliated hospitals (12.9%), 

no statistical difference was observed based on having a certified EHR system.

Figure 3. Office-based physicians with electronic health record systems who shared patient health information 

electronically with other providers, by certified electronic health record system status: United States, 2014

1

Differences between physicians with and without a certified system were significant; significance is tested at p < 0.05.

NOTES: Having a certified electronic health record (EHR) system was defined by physicians answering “yes” to “Does your current system meet meaningful 

use criteria as defined by the Department of Health and Human Services?” Sharing patient health information is defined as the electronic sharing of 

information such as lab results, imaging reports, problem lists, and medication lists. Sharing with external providers or unaffiliated hospitals is defined as 

sharing with either ambulatory care providers outside their group or hospitals with which their practice is not affiliated. Sharing with internal providers only is 

defined as sharing with providers inside their group or hospitals with which their practice is affiliated. 

SOURCE: CDC/NCHS, National Electronic Health Records Survey, 2014. 
NCHS Data Brief ■ No. 236 ■ January 2016

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Electronic sharing of patient health information with external providers 

or unaffiliated hospitals by office-based physicians with certified EHR 

systems varied across states.

● In 2014, the percentage of physicians with a certified EHR system who shared patient health 

information electronically with external providers ranged from 17.7% in New Jersey to 

58.8% in North Dakota (Figure 4).

● The percentage of physicians with a certified EHR system who shared patient health 

information electronically with external providers was significantly less than the national 

percentage (32.5%) in New Jersey (17.7%) and significantly greater than the national 

percentage in four states: Washington (46.3%), Massachusetts (48.7%), Oregon (49.9%), 

and North Dakota (58.8%).

Figure 4. Percentage of office-based physicians with a certified electronic health record system who shared patient health 

information electronically with external providers or unaffiliated hospitals, by state: United States, 2014

NOTES: Having a certified electronic health record system was defined by physicians answering “yes” to “Does your current system meet meaningful use 

criteria as defined by the Department of Health and Human Services?” Sharing patient health information is defined as the electronic sharing of information 

such as lab results, imaging reports, problem lists, and medication lists. Sharing with external providers or unaffiliated hospitals is defined as sharing with 

either ambulatory care providers outside their group or hospitals with which their practice is not affiliated. Estimate did not meet standards of reliability or 

precision for LA, NV, NM, TX, and WY. Significance is tested at p < 0.05.

SOURCE: CDC/NCHS, National Electronic Health Records Survey, 2014.

 
NCHS Data Brief ■ No. 236 ■ January 2016

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About 15% of physicians with a certified EHR system electronically shared 

patient information with home health, long-term care, or behavioral health 

providers.

● Among all physicians in 2014, roughly 1 in 10 shared patient health information 

electronically with behavioral health (11.4%), long-term care (10.6%), and home health 

(11.8%) providers (Figure 5).

● Among physicians with a certified EHR system in 2014, 14.0% shared patient health 

information electronically with behavioral health providers, 13.6% with long-term care 

providers, and 15.2% with home health providers.

● In 2014, a larger percentage of physicians with a certified EHR system who shared 

information electronically with external providers or unaffiliated hospitals also shared 

information electronically with behavioral health (33.3%), long-term care (36.2%), and 

home health (40.2%) providers compared with other physicians.

Figure 5. Physicians who shared patient health information electronically with behavioral health, long-term care, and 

home health providers, by certified electronic health record system status and sharing of information with external 

providers or unaffiliated hospitals: United States, 2014

NOTES: Having a certified electronic health record (EHR) system was defined by physicians answering “yes” to “Does your current system meet meaningful 

use criteria as defined by the Department of Health and Human Services?” Sharing patient health information is defined as the electronic sharing of 

information such as lab results, imaging reports, problem lists, and medication lists. Sharing with external providers or unaffiliated hospitals is defined as 

sharing with either ambulatory care providers outside their group or hospitals with which their practice is not affiliated. Differences across all provider sectors 

were significant between physicians with a certified electronic health record system who shared externally and either all physicians or physicians with a 

certified electronic health record system. Significance is tested at p < 0.05. 

SOURCE: CDC/NCHS, National Electronic Health Records Survey, 2014. 
NCHS Data Brief ■ No. 236 ■ January 2016

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Summary

Adoption of certified EHR systems by office-based physicians has increased from 2013 to 

2014. In 2014, 74.1% of office-based physicians had a certified EHR system. The percentage of 

physicians with a certified EHR system ranged from 58.8% in Alaska to 88.6% in Minnesota. 

The HITECH Act of 2009 gave eligible physicians monetary incentives to adopt a certified EHR 

system (2) and may be one of the reasons for the continued rise in physician adoption of these 

systems. 

In 2014, about one-third of physicians with a certified EHR system shared patient information 

with providers outside their physician group. The majority of physicians not using a certified 

EHR system did not exchange any patient health information with other providers. A larger 

percentage of physicians with a certified EHR system shared patient health information with other 

providers and hospitals than did physicians without a certified EHR system.

A small percentage of all physicians shared information with behavioral health, long-term care, 

and home health providers. A larger percentage of physicians with a certified EHR system 

shared information electronically with these providers if they also shared information with both 

ambulatory providers outside their group and unaffiliated hospitals.

HITECH provides funding to states to establish infrastructure that enables providers to share 

patient health information electronically (3). Physicians with a certified EHR system were sharing 

information in greater numbers than physicians without a certified EHR system.

Definitions

Certified electronic health record (EHR) system: The Medicare and Medicaid EHR Incentive 

Programs provide incentive payments to hospitals as they demonstrate meaningful use of 

certified EHR technology. The 2014 NEHRS asked physicians, “Does your current system 

meet meaningful use criteria as defined by the Department of Health and Human Services?” 

Physicians who answered “yes” were considered to have a certified EHR system.

Sharing patient health information: Physicians who exchange patient health information with 

other providers were defined by answering “yes” to “Do you share any patient health information 

(e.g., lab results, imaging reports, problem lists, medication lists) electronically (not fax) with any 

other providers, including hospitals, ambulatory providers, or labs?”

Office-based physicians reporting that they shared patient information with “external 

providers” shared patient health information electronically with either ambulatory care 

providers outside their group or hospitals with which their practice is not affiliated. Sharing 

information with external providers does not include home health, behavioral health, or 

long-term care providers.

Office-based physicians reporting that they shared patient health information with “internal 

providers” only shared patient health information electronically with providers in their 

group or affiliated hospitals but not with ambulatory care providers outside their group or 

hospitals with which their practice is not affiliated.
NCHS Data Brief ■ No. 236 ■ January 2016

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Data sources and methods

The National Ambulatory Medical Care Survey (NAMCS), which is conducted by the Centers 

for Disease Control and Prevention’s (CDC) National Center for Health Statistics, is an annual, 

nationally representative survey of office-based physicians that collects information on physician 

and practice characteristics, including the adoption and use of EHR systems. The universe of 

NAMCS physicians comprises those classified as providing direct patient care in office-based 

practices, as well as clinicians in community health centers. Radiologists, anesthesiologists, and 

pathologists are excluded. 

The 2014 estimates are from NEHRS, with a sample of 10,302 physicians. Nonrespondents to 

the mail survey received follow-up telephone calls. One-half of the 2014 NEHRS sample were 

randomly selected to receive a long-form questionnaire. The 2014 NEHRS was conducted from 

May through October 2014. The unweighted response rate of the 2014 NEHRS short-form 

questionnaire was 67% (66% weighted), whereas the unweighted response rate of the 2014 

NEHRS long-form questionnaire was 61% (60% weighted). The unweighted overall response rate 

was 64% (63% weighted). A copy of both questionnaire versions of the 2014 survey are available 

from the NCHS website at: http://www.cdc.gov/nchs/ahcd/ahcd_survey_instruments.htm#namcs. 

The data for this report are from the 2013 and 2014 NEHRS. It is designed to produce national 

and state-based estimates of office-based physicians’ adoption of EHR systems. Statements 

of differences in estimates are based on statistical tests with significance at the p < 0.05 level. 

Terms relating to differences such as “increased” or “less than” indicate that the differences are 

statistically significant. All differences are statistically significant unless stated otherwise.

Data analyses were performed using the statistical packages SAS version 9.3 (SAS Institute, 

Cary, N.C.) and SUDAAN version 10.0 (RTI International, Research Triangle Park, N.C.).

About the authors 

Eric W. Jamoom, Ninee Yang, and Esther Hing are with CDC’s National Center for Health 

Statistics, Division of Health Care Statistics, Ambulatory and Hospital Care Statistics Branch.

References

1. Blumenthal D, Tavenner M. The “meaningful use” regulation for electronic health records. 

N Engl J Med 363(6):501–4. 2010.

2. Centers for Medicare & Medicaid Services. Electronic Health Records (EHR) Incentive 

Programs. Baltimore, MD: Available from: https://www.cms.gov/Regulations-and-Guidance/

Legislation/EHRIncentivePrograms/index.html?redirect=/ehrincentiveprograms/.

3. Williams C, Mostashari F, Mentz K, Hogin E, Atwal P. From the Office of the National 

Coordinator: The strategy for advancing the exchange of health information. Health Aff 

(Millwood) 31(3):527–36. 2012.
NCHS Data Brief ■ No. 236 ■ January 2016

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Suggested citation

Jamoom EW, Yang N, Hing E. Adoption of 

certified electronic health record systems 

and electronic information sharing in 

physician offices: United States, 2013 and 

2014. NCHS data brief, no 236. Hyattsville, 

MD: National Center for Health Statistics. 

2016.

National Center for Health 

Statistics

Charles J. Rothwell, M.S., M.B.A., Director

Nathaniel Schenker, Ph.D., Deputy Director

Jennifer H. Madans, Ph.D., Associate 

Director for Science

Division of Health Care Statistics

Clarice Brown, M.S., Director

Alexander Strashny, Ph.D., Associate 

Director for Science