DEP-\RTi\lE1\T OF H tALTH A...ND HlTlVLAl'\T SERVICES' 

()FFICE <)F INSPECT{)R GENE.RAL 

TO: 

JUN 21 20ll 

Farzad Mostashari, M.D., Sc.M. 

National Coordinator for Health Information Technology 

Office of the National Coordinator 

for Health Information Technology 

Marilyn Tavenner 

Acting Administrator 

Centers for Medicare & Medicaid Services 

FROM: Stuart Wright 

Deputy Inspector General 

for Evaluation and Inspections 

SUBJECT: Memorandum Report: Use ofElectronic Health Record Systems in 2011 

Among Medicare Physicians Providing Evaluation and Management Services, 

OEI -04-10-00184 

This memorandum report responds to a request from officials of the Office of the 

National Coordinator for Health Information Technology (ONC), who expressed interest 

in information about physicians' reported use of electronic health record (EHR) systems. 

ONC officials made this request in connection with an ongoing evaluation on the extent 

ofdocumentation vulnerabilities of evaluation and management (ElM) services using 

EHR systems (OEI-04-10-00182), which will be issued separately. ONC officials also 

wanted to know how many and which EHR systems were being used and whether the 

Medicare physicians in our study were using certified EHR systems to document ElM 

services. We are also sending this report to the Centers for Medicare & Medicaid 

Services (CMS), which may find this information helpful as it continues administering its 

EHR incentive program. 

SUMMARY 

We found that 57 percent ofMedicare physicians used an EHR system at their primary 

practice location in 2011. Overall, 95 percent ofphysicians who used an EHR system to 

document EIl\1 services first began using it between 2001 and 2011. Ofthese physicians, 

the largest percentage (22 percent) began using EHR systems in 2011, the year that eMS 

commenced its incentive program. Additionally, three of every four Medicare physicians 

with an EHR system used a certified system to document ElM services. Finally, although 
 

 

 

 

 

 

 

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many EHR systems can assist physicians in assigning codes for E/M services, we found 

that most Medicare physicians manually assigned E/M codes. 

BACKGROUND 

Meaningful Use of Certified EHR Technology 

The HITECH Act of 2009 established the goal of achieving meaningful use of EHR 

technology in Medicare.1, 2 Meaningful use means that Medicare physicians use certified 

EHR technology in ways (e.g., electronic prescribing) that can be measured to improve 

the quality of health care for patients and adhere to the standards and criteria of the EHR 

incentive program.3, 4 Starting in 2015, physicians will be subject to Medicare payment 

reductions if they do not demonstrate meaningful use of certified EHR systems.5 

An EHR system is a computerized recordkeeping approach that allows physicians to 

record patient information electronically instead of using paper records.6 ONC is 

responsible for coordinating nationwide efforts to use health information technology, 

such as certified EHR systems, and for the electronic exchange of health information.7 

ONC has promulgated regulations pertaining to the initial set of standards and 

certification criteria and to the temporary and permanent certification programs.8 For 

instance, ONC’s rules contain security provisions, such as requiring that an EHR system 

be capable of maintaining audit logs, have automatic logoff, have access control, and 

permit emergency access.9 Additionally, ONC has coordinated with CMS to promulgate 

1 Title XIII of the American Recovery and Reinvestment Act of 2009, P.L. 111-5. See also, Department of 

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

Meaningful Use, August 2010.

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

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

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

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

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

5 SSA § 1848(a)(7). Regardless of whether physicians participate in the Medicare EHR incentive program, they
 

will be subject to Medicare payment reductions beginning in 2015 if they do not demonstrate meaningful use of 

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

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

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

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

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

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

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

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

9

 45 CFR §§ 170.302(o)-(r). 

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Page 3 – Farzad Mostashari, M.D., Sc.M.; Marilyn Tavenner 

the meaningful use criteria for the first stage of the EHR incentive program.10 

Physicians must demonstrate the meaningful use of certified EHR systems to avoid 

payment reductions beginning in 2015.11 EHR systems are certified by an Authorized 

Testing and Certification Body (ONC-ACTB) according to certification processes 

defined by ONC.12, 13 As of March 2012, approximately 1,200 EHR products were 

certified by ONC-ACTB. Certification criteria require that EHR systems have the 

necessary technological capability, functionality, and security to meet the applicable 

meaningful use criteria. These criteria can include the capability to maintain active 

medication allergy lists and provide clinical summaries for patients for each office visit, 

as defined in CMS regulation.14 However, companies (i.e., vendors) that develop and 

market EHR systems can include additional capabilities that are not required for the 

purposes of certification. 

In 2011, CMS began a three-stage, 5-year EHR incentive program with objectives that 

physicians must meet to demonstrate their meaningful use of certified EHR technology.15 

Each stage requires increasing use of EHR technology and electronic information 

exchange. For Stage 1, physicians must meet 15 core objectives (e.g., maintain active 

medication list) and 5 of 10 menu objectives (e.g., submit electronic data to immunization 

registries) to receive an EHR incentive payment.16 In March 2012, CMS issued a notice 

of proposed rulemaking to delineate the Stage 2 meaningful use requirements for certified 

EHR technology. Stage 3 meaningful use requirements are expected to be proposed in 

early 2014. 

E/M Services 

Physicians and nonphysician practitioners can use EHR systems to document E/M 

services, which are visits to assess and manage a patient’s health. Hereinafter, we refer to 

physicians and nonphysician practitioners as physicians.17 In 2010, approximately 

65 percent of all Medicare physicians billed for E/M services, accounting for 

$33.5 billion of $110 billion (30 percent) in total payments for Medicare Part B goods 

10 See CMS’s meaningful use regulations at 75 Fed. Reg. 44314 (July 28, 2010). 

11 Social Security Act § 1848(a)(7). 

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

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

2012. 

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

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

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

EHR Incentive Programs: Overview, April 2011.

16 42 CFR § 495.6. 

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

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

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Page 4 – Farzad Mostashari, M.D., Sc.M.; Marilyn Tavenner 

and services.18, 19 E/M services also represented 45 percent of the top 20 procedure codes 

billed to Medicare in 2010.20 

E/M services are grouped into visit types. Each visit type reflects the type of service, the 

place of service, and the patient’s status. For example, there are two types of office visits 

(new patient and established patient). Similarly, there are two types of hospital visits 

(initial and subsequent). 

Most E/M services are billed using codes that reflect the complexity of the service, 

ranging from lower level (i.e., less complex and less expensive) to higher level (i.e., more 

complex and more expensive) codes.21 Within each visit type, Medicare payment for the 

E/M service depends on the complexity of the visit. 

EHR Systems and E/M Coding 

Numerous EHR systems with various capabilities and features are available for purchase 

from vendors. For example, some EHR systems have add-on modules that automatically 

assign E/M codes based on the information provided by the physician.22 However, ONC 

has not established standards for how physicians should use EHR systems to create 

medical records that meet CMS documentation requirements for E/M services.23, 24 

Vendors can market these additional capabilities to physicians as tools to enhance E/M 

coding accuracy and efficiency, as well as to ensure that the highest E/M code is used to 

optimize revenue.25 Depending on the vendor, add-on modules may include broader 

applications of the coding software, such as generating diagnosis and complexity levels 

associated with an E/M code. Other modules can also provide feedback to describe how 

the code was derived. 

18 Office of Inspector General (OIG) analysis of 2010 National Claims History (NCH) File and 2010 Part B 

Analytic Reports (PBAR) National Procedure Summary File. 

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

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

beneficiary is responsible for paying the remaining 20 percent. 

20 OIG analysis of 2010 PBAR National Procedure Summary File. 

21 American Medical Association (AMA), Current Procedural Terminology, 2010. 

22 American Health Information Management Association (AHIMA), Automated Coding Software: 

Development and Use To Enhance Anti-Fraud Activities (HHSP23320054100EC), July 2005. 

23 Per CMS policy, physicians must use either the 1995 or 1997 Document Guidelines for Evaluation and 

Management Services to document the medical record with the appropriate clinical information to support the 

E/M code billed. CMS, Evaluation and Management Services Guide 2010, December 2010. 

24 AMA’s comments on ONC’s proposed rule, Health Information Technology: Standards, Implementation
 

Specifications, and Certification Criteria for Electronic Health Record Technology, 2014 Edition, May 2012. 

25 AHIMA, Automated Coding Software: Development and Use To Enhance Anti-Fraud Activities
 

(HHSP23320054100EC), July 2005. 

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Page 5 – Farzad Mostashari, M.D., Sc.M.; Marilyn Tavenner 

Related Work 

This evaluation is part of a series of studies by OIG on E/M services. OIG previously 

examined the coding trends of E/M services from 2001 to 2010 and identified physicians 

who consistently billed higher level (i.e., more complex and more expensive) codes in 

2010.26 Subsequent evaluations will determine the appropriateness of Medicare 

payments for E/M services and the extent of documentation vulnerabilities of E/M 

services using EHR systems. 

The Centers for Disease Control and Prevention (CDC) provides an annual report that 

describes trends in the use of EHR systems and physicians’ intentions to apply for EHR 

incentive payments. This report is based on a survey of office-based physicians who 

provide direct care to patients.27 In 2011, CDC found that 57 percent of office-based 

physicians reported using an EHR system at their practice location. CDC also found that 

34 percent of these physicians had an EHR system that met some of the meaningful use 

requirements. Additionally, 52 percent of office-based physicians reported their intention 

to apply for EHR incentive payments in 2011. 

METHODOLOGY 

Scope 

This memorandum report describes the extent to which Medicare physicians used EHR 

and certified EHR systems to document E/M services through 2011. Using claims data 

from a companion study on E/M services, we selected a simple random sample of 

2,000 Medicare physicians from a population of 441,990 physicians who provided at 

least 100 E/M services in 2010.28 

Data Collection and Analysis 

We conducted an electronic survey on our simple random sample of 2,000 Medicare 

physicians. We received responses from 1,506, for a 75-percent response rate. We 

conducted our survey between October 2011 and January 2012. 

26 OIG, Coding Trends of Medicare Evaluation and Management Services, OEI-04-10-00180, April 2012.

27 CDC, Electronic Health Record Systems and Intent to Apply for Meaningful Use Incentives Among OfficeBased Physician Practices: United States, 2001–2011, November 2011. CDC defined office-based physicians 

as nonfederally employed physicians located in the 50 States and the District of Columbia, excluding 

radiologists, anesthesiologists, and pathologists. 

28 OIG, Coding Trends of Medicare Evaluation and Management Services, OEI-04-10-00180, April 2012. We 

used the National Provider Identifier (NPI) field from the NCH carrier file to determine the number of 

physicians. We did not verify whether those NPIs were valid. Claims submitted by physicians who provided 

fewer than 100 E/M services represented less than 2 percent of Medicare payments and 30 percent of all 

physicians who provided E/M services. 

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Page 6 – Farzad Mostashari, M.D., Sc.M.; Marilyn Tavenner 

We collected descriptive information about physicians’ use of EHR systems for 

documenting E/M services. We asked Medicare physicians whether they currently used 

an EHR system at their primary practice locations.29 We defined “use” as having an EHR 

system that was purchased, installed, tested, and being utilized at the physician’s primary 

practice location.30 If physicians reported using EHR systems, we asked whether they 

used EHR systems to document E/M services.31 

We also asked Medicare physicians who currently used EHR systems to document E/M 

services to name the year they first started using this technology. We also asked these 

physicians how often they used EHR systems to document E/M services and whether 

E/M codes are manually assigned by the physician or staff. Additionally, we asked 

Medicare physicians which EHR system they used to document E/M services and 

whether their EHR system was certified. We then used ONC’s list of certified EHR 

technology to determine whether each physician’s EHR system was certified by an 

ONC-ACTB. 32 

All estimates in this report are projected to the specified population or subpopulation of 

Medicare physicians who provided E/M services in 2010, at the 95-percent confidence 

level. Appendix A shows the sample size, point estimates, and 95-percent confidence 

intervals for all statistics in this report. 

Limitations 

This study relies on self-reported data from Medicare physicians. We did not request 

documentation to verify their responses. 

Standards 

This study was conducted in accordance with the Quality Standards for Inspection and 

Evaluation approved by the Council of the Inspectors General on Integrity and 

Efficiency. 

29 We defined an EHR in our survey as an electronic health record of patient health information generated by one 

or more encounters to streamline the workflow in care-delivery organizations. 

30 We did not consider billing software as an EHR system. We excluded responses from 34 Medicare physicians 

because they reported using billing software instead of an EHR system.

31 Seventy-five respondents indicated that either they do not use or do not know whether they use an EHR 

system to document E/M services. We excluded responses from eight Medicare physicians because later in our 

survey, they indicated not using EHR systems to document E/M services. We also excluded responses from two 

Medicare physicians because they indicated first using an EHR system to document E/M services in 2012. 

32 ONC, Certified HIT Product List, December 2010. Accessed at http://oncchpl.force.com/ehrcert?q=CHPL on 

June 14, 2012. 

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Page 7 – Farzad Mostashari, M.D., Sc.M.; Marilyn Tavenner 

RESULTS 

Fifty-Seven Percent of Medicare Physicians Used EHR Systems at Their Primary 

Practice Locations in 2011 

Of the physicians who had an EHR system, 90 percent used their systems to document 

E/M services. See Table A-1 in Appendix A for the percentage of physicians who used 

an EHR system. 

Overall, 95 percent of physicians who used an EHR system in 2011 to document E/M 

services first began using an EHR system between 2001 and 2011, as shown in Table 1. 

During that time, the largest percentage of physicians (22 percent) began using EHR 

systems in 2011, the year that CMS commenced its EHR incentive program.33 See Table 

A-2 in Appendix A for the percentage of physicians who first used EHR systems to 

document E/M services each year from 1981 to 2011. 

Table 1: Medicare Physicians Who First Used an EHR System to Document E/M Services 

From 2001 to 2011 

Year Percentage of 

Physicians 

2001 0.53% 

2002 0.80% 

2003 2.26% 

2004 5.59% 

2005 8.51% 

2006 7.85% 

2007 8.91% 

2008 10.64% 

2009 12.10% 

2010 15.82% 

2011 22.47%

 Total 95.48% 

Source: OIG analysis of EHR survey data, 

2012. 

Approximately 72 percent of Medicare physicians who used an EHR system to document 

E/M services always used it to document E/M services. The remaining 28 percent used 

their EHR systems to document E/M services some of the time. Specifically, 16 percent 

of Medicare physicians used their EHR systems to document E/M services more than 

33 This percentage of physicians in 2011 was statistically higher than all other percentages for the years listed in 

Table 1 at the 95-percent confidence level. 

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Page 8 – Farzad Mostashari, M.D., Sc.M.; Marilyn Tavenner 

75 percent but less than 100 percent of the time, 8 percent from 50 to 75 percent of the 

time, and 4 percent less than 50 percent of the time. 

Although EHR systems can automatically assign codes for E/M services, 88 percent of 

Medicare physicians assigned codes manually in 2011. The remaining 12 percent had 

codes assigned manually by staff (e.g., professional coders). 

Three of Every Four Medicare Physicians With an EHR System Used Certified 

EHR Technology To Document E/M Services 

Of the Medicare physicians who used EHR systems at their primary practice locations, 

73 percent used a certified EHR system to document E/M services in 2011. Overall, 

physicians used more than 135 different EHR systems from more than 110 vendors. See 

Table A-3 in Appendix A for the percentage of Medicare physicians who used specific 

EHR systems by vendor. Sixty percent of Medicare physicians used a certified EHR 

system from one of nine vendors (see Table 2). See Table A-4 in Appendix A for the 

percentage of Medicare physicians who used certified EHR systems by the nine vendors 

listed in Table 2. 

Table 2: Nine Vendors of Certified EHR Systems Used By Most Medicare Physicians to 

Document E/M Services in 2011 

Vendor 

Percentage of 

Physicians 

Allscripts 10.90% 

eClinicalWorks, LLC. 9.04% 

GE Healthcare 8.64% 

NextGen Healthcare 8.24% 

Epic Systems Corporation 7.45% 

Greenway Medical Technologies, Inc. 5.19% 

Cerner Corporation 3.99% 

McKesson Corporation 3.72% 

Sage 3.06%

 Total* 60.24% 

*Total exceeds column sum because of rounding. 

Source: OIG analysis of EHR survey data, 2012. 

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Page 9 – Farzad Mostashari, M.D., Sc.M.; Marilyn Tavenner 

CONCLUSION 

ONC officials expressed interest in additional information about physicians’ use of EHR 

systems. They also wanted to know how many and which EHR systems were being used 

and whether the Medicare physicians in our study were using certified EHR systems to 

document E/M services. We provide this memorandum report to inform ONC about the 

use of both certified and noncertified EHR systems in 2011 among Medicare physicians 

who provided E/M services in 2010. Our results are consistent with CDC’s 2011 annual 

report on the use of EHR technology among office-based physicians. 

Additionally, CMS may find this information helpful as it continues administering its 

EHR incentive program. The use of EHR systems among Medicare physicians will likely 

continue to rise as more physicians participate in CMS’s EHR incentive program. Also, 

physicians will likely continue to adopt and implement certified EHR technology to avoid 

Medicare payment reductions starting in 2015. Information in this report can also 

provide CMS with insights regarding its EHR incentive program. 

This report is being issued directly in final form because it contains no recommendations. 

If you have comments or questions about this report, please provide them within 60 days. 

Please refer to report number OEI-04-10-00184 in all correspondence. 

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Appendix A 

Table A 1: Sample Sizes, Point Estimates, and Confidence Intervals for Medicare 

Physicians Who Used an Electronic Health Record System in 2011 

Estimate Description Sample 

Size 

Point 

Estimate 

95-Percent Confidence 

Interval 

Medicare physicians using an electronic health 

record (EHR) system at their primary practice 

locations 

1,472 56.73% 54.18%–59.24% 

Medicare physicians using an EHR system to 

document evaluation and management (E/M) 

services 

835 90.06% 87.83%–91.92% 

Medicare physicians using an EHR system to 

document E/M services who first began using an 

EHR system between 2001 and 2011 

752 95.48% 93.73%–96.75% 

Medicare physicians using an EHR system to 

document E/M services 100 percent of the time 752 71.68% 68.34%–74.79% 

Medicare physicians using an EHR system to 

document E/M services more than 75 but less 

than 100 percent of the time 

752 15.96% 13.51%–18.76% 

Medicare physicians using an EHR system to 

document E/M services from 50 to 75 percent of 

the time 

752 8.24% 6.48%–10.44% 

Medicare physicians using an EHR system to 

document E/M services less than 50 percent of 

the time 

752 4.12% 2.91%–5.81% 

Medicare physicians manually assigning E/M 

codes 752 87.77% 85.22%–89.93% 

Medicare physicians whose staff manually 

assign E/M codes 752 12.23% 10.07%–14.78% 

Medicare physicians using a certified EHR 

system at primary practice location 752 73.01% 69.71%–76.07% 

Medicare physicians using a certified EHR 

system from one of nine vendors* 752 60.24% 56.70%–63.67% 

*The nine vendors were Allscripts, eClinicalWorks, LLC., GE Healthcare, Epic Systems Corporation, Greenway Medical 

Technologies, Inc., Cerner Corporation, McKesson Corporation, and Sage. 

Source: Office of Inspector General (OIG) analysis of EHR survey data, 2012. 

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Appendix A 

Table A 2: Point Estimates and Confidence Intervals of Medicare 

Physicians Who First Used an EHR System to Document E/M 

Services From 1981 to 2011 (n 752) 

Year Point Estimate 95-Percent Confidence Interval 

1981 0.13% 0.02%–0.94% 

1990 0.13% 0.02%–0.94% 

1991 0.13% 0.02%–0.94% 

1994 0.40% 0.13%–1.23% 

1995 0.40% 0.13%–1.23% 

1996 0.13% 0.02%–0.94% 

1997 0.53% 0. 20%–1.41% 

1998 1.20% 0.62%–2.29% 

1999 0.27% 0.07%–1.06% 

2000 1.20% 0. 62%–2.29% 

2001 0.53% 0.20%–1.41% 

2002 0.80% 0.36%–1.77% 

2003 2.26% 1.40%–3.61% 

2004 5.59% 4.15%–7.48% 

2005 8.51% 6.71%–10.73% 

2006 7.85% 6.12%–10.00% 

2007 8.91% 7.07%–11.17% 

2008 10.64% 8.62%–13.06% 

2009 12.10% 9.95%–14.64% 

2010 15.82% 13.38%–18.62% 

2011 22.47% 19.62%–25.60% 

Total 100.00% --

Source: OIG analysis of EHR survey data, 2012. 

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Appendix A 

Table A 3: Point Estimates and Confidence Intervals for Medicare P

Used an EHR System by Vendor* (n=752) 

hysicians Who 

Vendor EHR System Point 

Estimate 

95-Percent 

Confidence Interval 

Acura Medical Solutions, 

Inc. mMD.Net EHR 0.13% 0.02%–0.94% 

Advanced Data Systems MedicsDocAssistant 0.40% 0.13%–1.23% 

Advanced Health 

Management Systems 

Advanced Health Management 

Systems EHR 0.13% 0.02%–0.94% 

Advanced MD Advanced MD EHR 0.27% 0.07%–1.05% 

Allmeds, Inc. Allmeds EMR 0.66% 0.28%–1.59% 

Allscripts Allscripts Enterprise 0.53% 0.20%–1.41% 

Allscripts Allscripts MyWay 0.80% 0.36%–1.76% 

Allscripts Allscripts PayerPath 0.13% 0.02%–0.94% 

Allscripts Allscripts Professional 1.46% 0.81%–2.62% 

Allscripts Allscripts Tiger 0.13% 0.02%–0.94% 

Allscripts Did Not Specify 5.32% 3.93%–7.17% 

Allscripts MediNotes 0.53% 0.20%–1.41% 

Allscripts Sunrise Ambulatory Care 0.13% 0.02%–0.94% 

Allscripts Sunrise Ambulatory Care Module 

Set 0.13% 0.02%–0.94% 

Allscripts Sunrise Clinical Manager 0.27% 0.07%–1.05% 

Allscripts TouchWorks 1.46% 0.81%–2.62% 

Allscripts-Misys Healthcare 

Solutions, Inc. MISYS Allscripts EHR 1.20% 0.62%–2.28% 

Altapoint Data Systems, 

LLC Altapoint EHR 0.40% 0.13%–1.23% 

Altos Solutions, Inc. OncoEMR 0.13% 0.02%–0.94% 

AmazingCharts.com, Inc. Amazing Charts 2.26% 1.41%–3.60% 

American Medical Software American Medical Software EMR 0.13% 0.02%–0.94% 

Antek HealthWare, LLC Alteer Office 0.80% 0.36%–1.76% 

*Vendors use the terms EHR and electronic medical record (EMR) systems interchangeably. 

continued on next page 

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Page 13 – Farzad Mostashari, M.D., Sc.M.; Marilyn Tavenner 

Appendix A 

Table A 3: Point Estimates and Confidence Intervals for Medicare Physicians Who Used 

an EHR System by Vendor * (n=752) (Continued) 

Vendor EHR System Point 

Estimate 

95-Percent 

Confidence Interval 

Aprima Medical Software, 

Inc. Aprima EHR 0.80% 0.36%–1.76% 

ASP.MD, Inc. ASP.MD Medical Office System 

(AMOS) 0.13% 0.02%–0.94% 

Bizmatics, Inc. PrognoCIS EMR 0.27% 0.07%–1.05% 

Cerner Corporation Cerner PowerChart 3.59% 2.48%–5.18% 

Cerner Corporation Cerner PowerWorks 0.40% 0.13%–1.23% 

ClearPractice ClearPractice 0.13% 0.02%–0.94% 

Community Computer 

Service, Inc. MEDENT 2.13% 1.31%–3.44% 

Compulink Business 

Systems Compulink 0.13% 0.02%–0.94% 

Comtron, Inc. Medgen EHR 0.27% 0.07%–1.05% 

Covemed Systems, Inc. Covemed EMR 0.13% 0.02%–0.94% 

Data Tec, Inc. PowersoftMD 0.27% 0.07%–1.05% 

Datanational eConnect Portal 0.27% 0.07%–1.05% 

DOX Podiatry DOX Podiatry EHR 0.13% 0.02%–0.94% 

eCast Corporation eCast EMR 0.27% 0.07%–1.05% 

eClinicalWorks, LLC eClinicalWorks 9.04% 7.19%–11.31% 

EDIMS, LLC EDIMS 0.13% 0.02%–0.94% 

EHR Scope, LLC CareSeries EHR 0.40% 0.13%–1.23% 

Elekta-IMPAC Medical 

Systems, Inc. Mosaiq 0.66% 0.28%–1.59% 

e-MDs, Inc. e-MDs Solution Series 0.27% 0.07%–1.05% 

Emergisoft Corporation Emergisoft EHR 0.13% 0.02%–0.94% 

Encite, Inc. Encite EHR 0.13% 0.02%–0.94% 

*Vendors use the terms EHR and EMR systems interchangeably. 

continued on next page 

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Appendix A 

Table A 3: Point Estimates and Confidence Intervals fo

an EHR System by Vendor * (n=752) (Continued) 

r Medicare Physicians Who Used 

Vendor EHR System Point 

Estimate 

95-Percent 

Confidence Interval 

Epic Systems Corporation Epic Care 0.40% 0.13%–1.23% 

Epic Systems Corporation Epic Care Ambulatory EMR 6.91% 5.31%–8.96% 

Epic Systems Corporation Excellian 0.13% 0.02%–0.94% 

Falcon, LLC Falcon EHR 0.27% 0.07%–1.05% 

First Insight Corporation MaximEyes SQL 0.13% 0.02%–0.94% 

Forerun, Inc. Forerun EHR 0.13% 0.02%–0.94% 

Gateway EDI Gateway EDI 0.13% 0.02%–0.94% 

GE Healthcare Centricity EMR 6.38% 4.85%–8.37% 

GE Healthcare Centricity Practice Solution 1.86% 1.11%–3.12% 

GE Healthcare IDX 0.27% 0.07%–1.05% 

GE Healthcare Logician EMR 0.13% 0.02%–0.94% 

GEMMS GEMMS One 0.93% 0.44%–1.94% 

Glenwood Systems, LLC GlaceEMR 0.27% 0.07%–1.05% 

gMed gGastro EMR 0.13% 0.02%–0.94% 

Greenway Medical 

Technologies, Inc. PrimeSUITE EHR 5.19% 3.81%–7.02% 

Health Innovation 

Technologies, Inc. Revolution EHR 0.27% 0.07%–1.05% 

Health IT Services Group Acumen EHR 0.66% 0.28%–1.59% 

Healthcare Management 

Systems, Inc. HMS Ambulatory EHR 0.27% 0.07%–1.05% 

HealthFusion MediTouch 0.27% 0.07%–1.05% 

Healthland Healthland EMR 0.13% 0.02%–0.94% 

Holt Systems eMedRec 0.27% 0.07%–1.05% 

* Vendors use the terms EHR and EMR systems interchangeably. 

continued on next page 

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Page 15 – Farzad Mostashari, M.D., Sc.M.; Marilyn Tavenner 

Appendix A 

Table A 3: Point Estimates and Confidence Intervals for Medicare Physicians Who Used 

an EHR System by Vendor * (n=752) (Continued) 

Vendor EHR System Point 

Estimate 

95-Percent 

Confidence Interval 

iMedCORE iMedCORE EMR 0.13% 0.02%–0.94% 

Infinite Software Solutions, 

Inc. MD-Reports 0.13% 0.02%–0.94% 

Infor-Med Medical 

Information Systems, Inc. Praxis EMR 0.53% 0.20%–1.41% 

InteGreat, Inc. IC-Chart 1.33% 0.72%–2.45% 

Intelligent Medical 

Objects, Inc. IMO Diagnosis Code Check 0.13% 0.02%–0.94% 

Internally Developed 

System Internally Developed System 1.20% 0.62%–2.28% 

Intuitive Medical Software, 

LLC Urochart EHR 0.13% 0.02%–0.94% 

iSALUS Healthcare OfficeEMR 0.27% 0.07%–1.05% 

ISM, Inc. OmniMD 0.13% 0.02%–0.94% 

iton MedicsDocAssistant 0.40% 0.13%–1.23% 

Kaiser Computers, Inc. Drs Enterprise 0.13% 0.02%–0.94% 

Lake Superior Software, 

Inc. 

Medical and Practice 

Management (MPM) Suite 

MAGIC 

0.27% 0.07%–1.05% 

Liquid Medical Office, Inc. Liquid EMR 0.13% 0.02%–0.94% 

LSS Data Systems LSS 0.27% 0.07%–1.05% 

MacPractice, Inc. MacPractice MD 0.13% 0.02%–0.94% 

McKesson Corporation Horizon Ambulatory Care 0.66% 0.28%–1.59% 

McKesson Corporation Horizon Clinicals 0.27% 0.07%–1.05% 

McKesson Corporation iKnowmed EHR 0.80% 0.36%–1.76% 

McKesson Corporation Medisoft Clinical 0.40% 0.13%–1.23% 

McKesson Corporation Practice Partner Patient Records 1.46% 0.81%–2.62% 

McKesson Corporation Did Not Specify 0.13% 0.02%–0.94% 

* Vendors use the terms EHR and EMR systems interchangeably. 

continued on next page 

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Page 16 – Farzad Mostashari, M.D., Sc.M.; Marilyn Tavenner 

Appendix A 

Table A 3: Point Estimates and Confidence Intervals for Medicare Physicians Who Used 

an EHR System by Vendor * (n=752) (Continued) 

Vendor EHR System Point 

Estimate 

95-Percent 

Confidence Interval 

MD Productivity, Inc. MD Dictate 0.13% 0.02%–0.94% 

MED3000 MED3000 0.40% 0.13%–1.23% 

Medamation, LLC Medamation 0.13% 0.02%–0.94% 

MedAptus, Inc. MedAptus EMR 0.13% 0.02%–0.94% 

MedcomSoft MedcomSoft Record 0.13% 0.02%–0.94% 

Medhost, Inc. Medhost 0.27% 0.07%–1.05% 

Medical Informatics 

Engineering Did Not Specify 0.13% 0.02%–0.94% 

Medical Information 

Technology, Inc. MEDITECH 0.40% 0.13%–1.23% 

Medical Software 

Associates IMS EMR 0.66% 0.28%–1.59% 

MedInformatix MedInformatix Enterprise Practice 

Management 0.93% 0.44%–1.94% 

MediSYS MediSYS EHR 0.40% 0.13%–1.23% 

Meditab IMS Clinical 0.13% 0.02%–0.94% 

meridianEMR, Inc. meridianEMR 0.80% 0.36%–1.76% 

Microfour, Inc. PracticeStudio 0.27% 0.07%–1.05% 

Navinet, Inc. Navinet EMR 0.13% 0.02%–0.94% 

NexTech Systems, Inc. NexTech 0.13% 0.02%–0.94% 

NextGen Healthcare NextGen 8.24% 6.48%–10.43% 

Noteworthy Medical 

Systems, Inc. NetPracticeEHRweb 0.13% 0.02%–0.94% 

OCERIS, Inc. FlexMedical 0.13% 0.02%–0.94% 

Office Ally Office Ally EHR 24/7 0.27% 0.07%–1.05% 

* Vendors use the terms EHR and EMR systems interchangeably. 

continued on next page 

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Page 17 – Farzad Mostashari, M.D., Sc.M.; Marilyn Tavenner 

 

Appendix A 

Table A 3: Point Estimates and Confidence Intervals for Medicare Physicians Who Used - 

an EHR System by Vendor * (n=752) (Continued) 

Vendor EHR System Point 

Estimate 

95-Percent 

Confidence Interval 

Practice Fusion, Inc. Practice Fusion 1.73% 1.01%–2.95% 

Prime Clinical Systems Patient Chart Manager 0.40% 0.13%–1.23% 

ProMED Clinical Systems ProMED 0.40% 0.13%–1.23% 

Propractica, Inc. StreamlineMD EMR 0.13% 0.02%–0.94% 

Pulse, Inc. Pulse EHR 0.66% 0.28%–1.59% 

QuadraMed QuadraMed EHR 0.13% 0.02%–0.94% 

Quest Diagnostics 

Incorporated Care 360 0.53% 0.20%–1.41% 

Sage Sage Intergy EHR 3.06% 2.04%–4.56% 

Siemans INVISION 0.13% 0.02%–0.94% 

Siemans Soarian 0.27% 0.07%–1.05% 

SOAPware, Inc. SOAPware 1.73% 1.01%–2.95% 

SRS Software, Inc. SRS Chart Manager 0.66% 0.28%–1.59% 

STI Computer Services, 

Inc. ChartMaker Clinical 0.40% 0.13%–1.23% 

SuccessEHS SuccessEHS 0.53% 0.20%–1.41% 

Treasure Coast 

Management Group HealthMatics EHR 1.46% 0.81%–2.62% 

T-System, Inc. T-System 0.13% 0.02%–0.94% 

U.S. Department of 

Veterans Affairs 

Computerized Patient Record 

System 0.13% 0.02%–0.94% 

Ulrich Medical Concepts Team Chart Concept 0.27% 0.07%–1.05% 

University of California Los 

Angeles Healthcare 

System 

UCLA Healthcare System 

Medical Record 0.13% 0.02%–0.94% 

Urgent Care Works Urgent Care Works EMR 0.13% 0.02%–0.94% 

Varian Medical Systems ARIA 0.27% 0.07%–1.05% 

* Vendors use the terms EHR and EMR systems interchangeably. 

continued on next page 

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Page 18 – Farzad Mostashari, M.D., Sc.M.; Marilyn Tavenner 

 

Appendix A 

Table A 3: Point Estimates and Confidence Intervals for Medicare Physicians Who 

Used an EHR System by Vendor * (n=752) (Continued) 

Vendor EHR System Point 

Estimate 

95-Percent Confidence 

Interval 

VersaForm Corporation VersaForm EHR 0.13% 0.02%–0.94% 

Visionary Medical 

Systems, Inc. Dream EMR 0.27% 0.07%–1.05% 

Waiting Room Solutions Waiting Room Solutions 

EHR 0.13% 0.02%–0.94% 

Wyoming Department of 

Health Total Health Record 0.13% 0.02%–0.94% 

Don’t Know Don’t Know 0.27% 0.07%–1.05% 

Unknown CarePlus 0.13% 0.02%–0.94% 

Unknown digital medicine 0.13% 0.02%–0.94% 

Unknown MD Logic 0.13% 0.02%–0.94% 

Unknown Urgent Care 0.13% 0.02%–0.94% 

* Vendors use the terms EHR and EMR systems interchangeably. 

Source: OIG analysis of EHR survey data, 2012. 

Use of EHR Systems in 2011 Among Medicare Physicians Providing E/M Services OEI-04-10-00184 
 

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Page 19 – Farzad Mostashari, M.D., Sc.M.; Marilyn Tavenner 

Appendix A 

Table A 4: Point Estimates and Confiden

EHR Systems (n 752) 

ce Intervals for Nine Vendors With Certified 

Vendor Point 

Estimate 

95-Percent Confidence 

Interval 

Allscripts 10.90% 8.87%–13.34% 

Cerner Corporation 3.99% 2.80%–5.65% 

eClinicalWorks, LLC. 9.04% 7.19%–11.31% 

Epic Systems Corporation 7.45% 5.78%–9.55% 

GE Healthcare 8.64% 6.84%–10.87% 

Greenway Medical Technologies, Inc. 5.19% 3.81%–7.02% 

McKesson Corporation 3.72% 2.58%–5.34% 

NextGen Healthcare 8.24% 6.48%–10.43% 

Sage 3.06% 2.04%–4.56% 

Source: OIG analysis of EHR survey data, 2012. 

Use of EHR Systems in 2011 Among Medicare Physicians Providing E/M Services OEI-04-10-00184