NCHS Data Brief ■ No. 111 ■ December 2012

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics

Use and Characteristics of Electronic Health Record Systems 

Among Office-based Physician Practices: 

United States, 2001–2012

Chun-Ju Hsiao, Ph.D., and Esther Hing, M.P.H.

The 2009 Health Information Technology for Economic and Clinical Health 

Act, also known as the HITECH Act, authorized incentive payments through the 

Medicare and Medicaid programs to increase physician adoption of electronic 

health record (EHR) systems (1,2). To receive an EHR incentive payment, 

physicians must show that they are “meaningfully using” certified EHRs by 

meeting certain objectives (3,4). This report describes trends in adoption of 

electronic medical record or electronic health record (EMR/EHR) systems from 

2001 to 2012, as well as physicians’ intent to participate in the EHR Incentive 

Programs and their readiness to meet 13 of the Stage 1 Core Set objectives for 

“meaningful use” in 2012, the second year of the incentive programs. Data are 

reported from the 2012 mail survey of physicians in the National Ambulatory 

Medical Care Survey (NAMCS) and earlier years of NAMCS.

Keywords: health information technology • National Ambulatory Medical 

Care Survey

Adoption of EMR/EHR systems by office-based physicians 

has increased.

Key findings

• In 2012, 72% of office-based 

physicians used electronic 

medical record or electronic 

health record (EMR/EHR) 

systems, up from 48% in 2009. 

EMR/EHR use ranged from 

54% in New Jersey to 89% in 

Massachusetts.

• About 40% of office-based 

physicians reported having a 

system that met the criteria for 

a basic system, up from 22% 

in 2009. The percentage of 

physicians with these systems 

ranged from 22% in the 

District of Columbia to 71% in 

Wisconsin.

• In 2012, 66% of office-based 

physicians reported that they 

planned to apply, or already had 

applied, for “meaningful use” 

incentives.

• In 2012, 27% of office-based 

physicians who planned to 

apply or already had applied 

for meaningful use incentives 

had computerized systems with 

capabilities to support 13 of the 

Stage 1 Core Set objectives for 

meaningful use.

Any EMR/EHR system

Basic system 18.2 17.3 17.3 20.8

10.5 11.8

16.9

21.8

27.9

33.9

39.6

23.9

29.2

34.8

42.0

48.3 51.0

57.0

71.8

Percent of physicians

0

20

40

60

80

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

Figure 1. Percentage of office-based physicians with EMR/EHR systems: United States, 

2001–2010 and preliminary 2011–2012

NOTES: EMR/EHR is electronic medical record/electronic health record. “Any EMR/EHR system” is a medical or health record

system that is all or partially electronic (excluding systems solely for billing). Data for 2001–2007 are from in-person National

Ambulatory Medical Care Survey (NAMCS) interviews. Data for 2008–2010 are from combined files (in-person NAMCS and 

mail survey). Data for 2011–2012 are preliminary estimates (dashed lines) based on the mail survey only. Estimates of basic

systems prior to 2006 could not be computed because some items were not collected in the survey. Data include nonfederal

office-based physicians and exclude radiologists, anesthesiologists, and pathologists.

SOURCE: CDC/NCHS, National Ambulatory Medical Care Survey, 2001–2012.
NCHS Data Brief ■ No. 111 ■ December 2012

■  2  ■

• EMR/EHR system use among office-based physicians increased from 18% in 2001 to 72% in 

the preliminary 2012 estimates, a 26% increase over the 2011 estimate (57%) (Figure 1).

• About 40% of physicians reported having a system that met the criteria for a basic system, a 

17% increase over the 2011 estimate (34%).

Adoption of EMR/EHR systems by office-based physicians varied by state.

• In 2012, the percentage of physicians using any EMR/EHR system varied by state, ranging 

from 54% in New Jersey to 89% in Massachusetts (Table 1).

Table 1. Percentage of office-based physicians using any EMR/EHR system and percentage of physicians with basic

systems, by state: United States, preliminary 2012

State Any 

system

Basic 

system State Any 

system 

Basic 

system

Percent Percent

United States 71.8 39.6 Missouri 75.8 48.8

Alabama 66.4 35.2 Montana 65.8 36.2

Alaska 72.7 36.1 Nebraska 71.4 33.0

Arizona †

82.4 47.8 Nevada 74.5 33.8

Arkansas 69.9 46.1 New Hampshire 74.9 44.9

California 80.3 36.8 New Jersey §

53.8 §26.9

Colorado 72.8 39.6 New Mexico 71.5 42.8

Connecticut §

56.5 §26.9 New York 71.7 43.5

Delaware †

83.2 53.2 North Carolina †80.7 48.3

District of Columbia 65.8 §22.4 North Dakota †87.0 †63.2

Florida 66.1 41.7 Ohio 69.1 34.3

Georgia 74.1 §

28.3 Oklahoma 67.8 40.3

Hawaii †

86.3 36.6 Oregon 76.7 38.4

Idaho 72.8 41.6 Pennsylvania 71.0 35.1

Illinois §

54.1 36.1 Rhode Island 71.2 37.1

Indiana 74.0 39.3 South Carolina 65.5 29.7

Iowa †

85.0 †54.9 South Dakota †84.9 †53.2

Kansas 74.8 36.6 Tennessee 70.9 40.7

Kentucky 64.9 §

27.2 Texas 66.8 33.3

Louisiana §

58.3 §25.0 Utah †83.8 †60.8

Maine 70.1 37.8 Vermont 77.4 36.1

Maryland 66.5 §

27.4 Virginia 68.9 30.2

Massachusetts †

89.2 †61.8 Washington 78.3 48.7

Michigan 66.6 37.5 West Virginia 70.3 39.1

Minnesota †

85.1 †66.7 Wisconsin †82.9 †70.6

Mississippi 64.1 32.5 Wyoming 70.0 33.5

† Significantly higher than national average (p < 0.05). § Significantly lower than national average (p < 0.05).

NOTES: EMR/EHR is electronic medical record/electronic health record. Data for states include the District of Columbia.

SOURCE: CDC/NCHS, National Ambulatory Medical Care Survey, 2012.
NCHS Data Brief ■ No. 111 ■ December 2012

■  3  ■

• Compared with the national average (72%), the percentage of physicians using any 

EMR/EHR system was lower in 4 states (Connecticut, Illinois, Louisiana, and New Jersey) and 

higher in 11 states (Arizona, Delaware, Hawaii, Iowa, Massachusetts, Minnesota, North Carolina, 

North Dakota, South Dakota, Utah, and Wisconsin).

• The percentage of physicians who had systems meeting the criteria for a basic system, by state 

and the District of Columbia, ranged from 22% in the District of Columbia to 71% in Wisconsin.

• The percentage of physicians who had systems meeting the criteria for a basic system was 

lower in the District of Columbia and six states (Connecticut, Georgia, Kentucky, Louisiana, 

Maryland, and New Jersey) and higher in seven states (Iowa, Massachusetts, Minnesota, North 

Dakota, South Dakota, Utah, and Wisconsin) compared with the national average (40%).

About two-thirds of physicians intended to participate in the Medicare or 

Medicaid EHR Incentive Programs as of 2012.

• In 2012, 66% of physicians intended to participate [i.e., already applied (41%) or intended to 

apply (25%)] in the Medicare or Medicaid incentive program (Figure 2).

OR

66.9

CA

58.4

AZ

63.0

AK

47.8

HI

52.4

NM

63.3

TX

61.5 LA

55.8

MS

67.1

AL

68.9

GA

58.1

OH

66.7

FL

64.7

AR

81.0

MO

70.1

TN

68.8

KY

67.4

NE

78.5

OK

64.0

KS

79.1

NV

62.7 UT

64.0 CO

63.9

WA

72.9

ID

70.6

MT

70.4

ND

68.7

WY

61.3

SD

82.2

WI

73.7 MI

73.3

ME

66.8

NH

68.4

MA

78.7

RI

67.9

CT

69.3

NJ

66.1

DE

85.0

VT

61.8

NY

61.0

PA

71.6

WV

67.6 VA

64.0 MD

60.6

DC

51.2

NC

73.3

SC

72.6

IN

73.3

IL

53.7

MN

64.3

IA

76.3

National

average: 65.5%

Not significantly different

from national average

Significantly higher

than national average

Significantly lower

than national average

Figure 2. Percentage of office-based physicians intending to participate in meaningful use incentive programs, by state: 

United States, preliminary 2012

NOTES: Intent to participate in meaningful use incentive program was obtained from responses to the question, “Medicare and Medicaid offer incentives to 

practices that demonstrate ‘meaningful use of health IT.’ At this practice, are there plans to apply for these incentive payments?” Intent to participate includes 

“already applied” (40.5%) and “intend to apply” (25.0%). In 2012, 22.4% of physicians were uncertain about participating and 12.1% did not plan to participate. 

Estimates exclude missing data on the question. 

SOURCE: CDC/NCHS, National Ambulatory Medical Care Survey, 2012.
NCHS Data Brief ■ No. 111 ■ December 2012

■  4  ■

• Intent to participate in the incentive programs ranged from 48% in Alaska to 85% in Delaware.

• The percentage of physicians intending to participate in the incentive programs was lower 

than the national average (66%) in two states (Alaska and Illinois) and higher in seven states 

(Arkansas, Delaware, Iowa, Kansas, Massachusetts, Nebraska, and South Dakota).

• The proportion of physicians intending to participate rose from 52% in 2011 (5) to 66% in 2012.

In 2012, about one-quarter of physicians intending to participate in the EHR 

Incentive Programs had computerized systems with capabilities to support 

13 of the Stage 1 Core Set objectives for meaningful use.

• Among physicians intending to participate in the EHR Incentive Programs, 27% had 

computerized systems capable of supporting 13 Stage 1 Core Set objectives (Figure 3, Table 2).

• The percentage of physicians intending to participate in the EHR Incentive Programs who 

had computerized systems able to support 13 of the Stage 1 core objectives for meaningful use 

varied by state—from 17% in North Dakota to 39% in Wisconsin. Five states (Alaska, Delaware, 

Kentucky, Louisiana, and Mississippi) and the District of Columbia were excluded due to 

unreliable estimates. Although percentages varied by state, no state was statistically different 

from the national average.

OR

22.5

CA

32.6

AZ

31.3

AK

18.0

HI

28.9

NM

18.3

TX

21.6 LA

16.7

MS

13.1

AL

22.3

GA

30.3

OH

22.6

FL

29.0

AR

37.9

MO

29.9

TN

29.1

KY

16.1

NE

29.6

OK

19.0

KS

32.0

NV

32.1 UT

21.5 CO

27.0

WA

23.2

ID

22.4

MT

21.2

ND

17.3

WY

20.1

SD

30.6

WI

38.5 MI

21.5

ME

25.4

NH

17.7

MA

37.4

RI

31.7

CT

29.0

NJ

23.3

DE

36.4

VT

33.0

NY

25.6

PA

18.9

WV

35.0 VA

27.5 MD

28.4

DC

8.7

NC

27.6

SC

20.1

IN

32.2

IL

28.3

MN

35.5

IA

23.8

Reliable estimate Unreliable estimate National average: 26.9%

Figure 3. Percentage of physicians intending to participate in Medicare and Medicaid EHR Incentive Programs who had 

EHRs capable of supporting 13 Stage 1 Core Set objectives, by state: United States, preliminary 2012

NOTES: EHR is electronic health record. See Table 2 for Stage 1 Core Set meaningful use objectives and corresponding survey item.

SOURCE: CDC/NCHS, National Ambulatory Medical Care Survey, 2012.
NCHS Data Brief ■ No. 111 ■ December 2012

■  5  ■

Table 2. Meaningful use Core Set objectives and corresponding NAMCS survey items

2011–2012 Meaningful use Core Set objective Corresponding 2012 NAMCS survey items on 

computerized functions

Computerized provider order entry for medications Prescription order entry

Drug-drug and drug-allergy interaction checks Drug interaction or contraindication 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

allergies

Maintain active medication allergy list (Combined in preceding item)

Vital signs Recording and charting vital signs

Smoking status Recording patient smoking status

Implement one clinical decision support rule and ability to

track compliance with rule

Reminders for guideline-based interventions or

screening tests AND warnings of drug interactions or

contraindications provided

Calculate and transmit Centers for Medicare & Medicaid

Services (CMS) quality measure

Reporting clinical quality measures to federal or state

agencies (such as CMS or Medicaid)

Electronic copy of health information Providing patients with electronic copy of their health

information

Clinical summaries Providing patients with clinical summaries for each visit

Exchange key clinical information ...

Privacy/security ...

... Data not available.

NOTES: NAMCS is National Ambulatory Medical Care Survey. In August 2012, CMS announced a final rule to govern Stage 2 of the EHR Incentive Programs

with updates to Stage 1 objectives (see reference 4). Because the changes to Stage 1 objectives are not effective until 2013 or 2014, the original Stage 1

objectives were used rather than the updated version to provide a snapshot of physicians’ readiness to meet Stage 1 meaningful use measures as of 2012.

Summary

EMR/EHR use among office-based physicians has increased from 2001 through 2012. In 2012, 

the NAMCS mail survey showed that about 72% of office-based physicians used any EMR/EHR 

system, a 26% increase from the 2011 estimate (57%). From 2011 to 2012, the percentage of 

physicians who reported having a system that met the criteria for a basic system increased from 

34% to 40%.

Adoption of EMR/EHR systems varied greatly by state. In 2012, the percentage of physicians 

using any EMR/EHR system ranged from 54% in New Jersey to 89% in Massachusetts. The 

percentage of physicians having a system that met the criteria for a basic system had a wider 

range of adoption by state (from 22% in the District of Columbia to 71% in Wisconsin).

In 2012, 66% of physicians reported intending to participate (having already applied or intending 

to apply) in the Medicare or Medicaid EHR Incentive Programs. Intent to participate among 

physicians also varied by state. Compared with the national average, two states had a significantly 

lower percentage of physicians intending to participate, and seven states had a significantly higher 

percentage.

To qualify for Stage 1 meaningful use incentive payments as of 2012, eligible physicians must 

meet all 15 of the Stage 1 core objectives for meaningful use, and 5 of 10 Menu Set objectives, 
NCHS Data Brief ■ No. 111 ■ December 2012

■  6  ■

using certified EHR systems (4). In this report, estimates of physicians’ readiness to meet 

meaningful use measures were limited to data collected on the capabilities of EHRs to support 

13 of the Stage 1 objectives. In the present study, among physicians who had already applied or 

intended to apply for incentives, 27% had EHR systems capable of supporting 13 of the Stage 1 

core objectives for meaningful use, which is an overestimate of the percentage meeting the 2012 

requirements. Some physicians with systems supporting the 13 core objectives examined in this 

report may not have a system that supports the remaining 2 objectives, as well as 5 of the 10 

Menu Set objectives required for payment.

Definitions

Physician office: A place where nonfederally employed physicians provide direct patient care in the 

50 states and the District of Columbia; excludes radiologists, anesthesiologists, and pathologists.

Any EMR/EHR system: Obtained from “yes” responses to the question, “Does this practice use 

electronic medical records or electronic health records (not including billing records)?”

Basic EMR/EHR system: A system that has all of the following functionalities: patient history 

and demographics, patient problem lists, physician clinical notes, comprehensive list of patients’

medications and allergies, computerized orders for prescriptions, and ability to view laboratory 

and imaging results electronically (6). Having a comprehensive list of patients’ medications and 

allergies was asked as two separate questions in 2010 (one about medications and the other about 

allergies), but the questions were collapsed into one question in 2011 and 2012 (5).

Intent to apply for Medicare or Medicaid EHR Incentive Programs: Obtained from “yes, 

we already applied” and “yes, we intend to apply” responses to the question, “Medicare and 

Medicaid offer incentives to practices that demonstrate ‘meaningful use of health IT.’ At this 

practice, are there plans to apply for these incentive payments?”

Demonstrating meaningful use: The Medicare and Medicaid EHR Incentive Programs provide 

incentive payments to physicians as they demonstrate meaningful use of certified EHR 

technology. The Centers for Medicare & Medicaid Services has established the objectives 

for meaningful use in three stages that physicians must meet in order to receive an incentive 

payment. In 2011 and 2012, physicians could receive incentive payments if they demonstrated 15 

of the Stage 1 core objectives for meaningful use, and 5 of 10 Menu Set objectives, using certified 

EHR systems. Physicians demonstrate meaningful use objectives through associated measures or 

by attesting to an objective (1). For example, physicians with computerized provider order entry 

(CPOE) demonstrate the CPOE objective for medication orders with a measure indicating that at 

least 30% of their patients had one or more medications ordered through CPOE (1). On the other 

hand, physicians who have drug-drug and drug-allergy interaction checks meet this objective by 

attesting that the functionality was enabled (1). The full list of Stage 1 objectives and measures is 

published (1,2).

The 2012 estimate of physicians’ readiness to meet Stage 1 objectives is not comparable with 

previously reported estimates (5,7) because more information on Stage 1 core functionalities 

was collected in 2012 (13 of 15) than in 2011 (10 of 15) or 2010 (8 of 15). Table 2 presents 

Stage 1 meaningful use Core Set objectives and corresponding 2012 NAMCS survey items on 

EHR system functions.
NCHS Data Brief ■ No. 111 ■ December 2012

■  7  ■

Data source and methods

NAMCS, conducted by the Centers for Disease Control and Prevention’s (CDC) National Center 

for Health Statistics (NCHS), is an annual, nationally representative survey of office-based 

physicians that collects information on the adoption and use of EMR/EHR systems. The target 

universe of NAMCS physicians comprises those classified as providing direct patient care in 

office-based practices, including additional clinicians in community health centers. Radiologists, 

anesthesiologists, and pathologists are excluded.

Since 2008, a supplemental mail survey on EMR/EHR systems has been conducted in addition to 

the core NAMCS, which is an in-person survey. In 2008 and 2009, samples of physicians in the 

core, in-person NAMCS and the supplemental mail survey, stratified by specialty, were chosen 

from selected geographic areas. Starting in 2010, the mail survey sample size was increased 

fivefold to allow for state-level estimates. Survey questions added in 2010 and continued in 2012 

ask a physician’s intent to apply for meaningful use incentive payments. In 2012, the survey also 

included more detailed questions on health information exchange.

The 2012 estimates are from the NAMCS mail surveys with a sample of 10,302 physicians. 

Nonrespondents to the mail survey received follow-up telephone calls. The 2012 mail survey was 

conducted from February through mid-July 2012. The unweighted response rates of the 2012 

mail surveys were 67% (65% weighted). A copy of the 2012 survey is available from the NCHS 

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

Physicians’ updated practice location information was used to generate state-level estimates. 

Estimates of intent to apply for incentives exclude about 1.6% of cases with missing information. 

Estimates of physician readiness to meet Stage 1 objectives were obtained by calculating EHRs 

that had all of the following features: recording patient demographic information, current problems, 

vital signs, smoking status, medications, and patient allergies; having computerized provider order 

entry for medications; sending prescriptions electronically to the pharmacy; providing drug-drug 

and drug-allergy alerts; having at least one clinical decision support rule implemented; reporting 

clinical quality measures to federal or state agencies; and providing patients with an electronic 

copy of their health information and with clinical summaries for each visit.

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 “decreased,” indicate that the 

differences are statistically significant. A lack of comment regarding the difference does not mean 

that the difference was tested and found to be not significant.

About the authors

Chun-Ju Hsiao and Esther Hing are with CDC’s NCHS, Division of Health Care Statistics, 

Ambulatory and Hospital Care Statistics Branch.
NCHS Data Brief ■ No. 111 ■ December 2012

References

1. Centers for Medicare & Medicaid Services. [Medicare and Medicaid] 

EHR Incentive Programs. Available from: https://www.cms.gov/

ehrincentiveprograms/.

2. Blumenthal D, Tavenner M. The “meaningful use” regulation for 

electronic health records. N Engl J Med 363(6):501–4. 2010.

3. Centers for Medicare & Medicaid Services. Medicare and Medicaid 

Programs; Electronic Health Record Incentive Program—Stage 2; Health 

information technology: Standards, implementation specifications, and 

certification criteria for electronic health record technology, 2014 edition; 

Revisions to the Permanent Certification Program for Health Information 

Technology. Final rule. Fed Regist 77(171):53968–4162. 2012.

4. Centers for Medicare & Medicaid Services. Medicare and Medicaid 

Programs; Electronic Health Record Incentive Program. Final rule. Fed 

Regist 75(144):44314–588. 2010.

5. 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.

6. Health information technology in the United States: Where we stand, 

2008. Robert Wood Johnson Foundation. 2008.

7. Hsiao CJ, Decker SL, Hing E, Sisk JE. Most physicians were eligible for 

federal incentives in 2011, but few had EHR systems that met meaningfuluse criteria. Health Aff 31(5):1100–7. 2012. 

Suggested citation

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.

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

Edward J. Sondik, Ph.D., Director

Jennifer H. Madans, Ph.D., Associate 

Director for Science

Division of Health Care Statistics

Clarice Brown, M.S., Director

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