NCHS Data Brief ■ No. 129 ■ September 2013

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics

Key findings

Data from the National 

Ambulatory Medical 

Care Survey’s (NAMCS) 

Physician Workflow 

Survey, 2011

• About three-quarters of 

physicians with electronic health 

record (EHR) systems have 

systems that meet meaningful use 

criteria.

• Physicians with EHR systems 

that meet meaningful use criteria 

were more likely to report that 

their system provides time savings 

than physicians with systems not 

meeting meaningful use criteria, 

but only in some areas.

• Physicians with EHR systems 

that meet meaningful use criteria 

were more likely to report 

enhanced confidentiality and less 

disruption in their interactions 

with patients than physicians with 

systems not meeting meaningful 

use criteria.

• Physicians with EHR systems 

that meet meaningful use criteria 

were no more likely to report 

financial benefits and selected 

clinical benefits than those with 

systems not meeting meaningful 

use criteria.

Physician Experience With Electronic Health Record Systems 

That Meet Meaningful Use Criteria: NAMCS Physician 

Workflow Survey, 2011

Eric Jamoom, Ph.D., M.P.H., M.S.; Vaishali Patel, M.P.H., Ph.D.; Jennifer King, Ph.D.; and 

Michael F. Furukawa, Ph.D.

The Health Information Technology for Economic and Clinical Health 

(HITECH) Act of 2009 provides financial incentives for physicians who 

adopt and demonstrate the “meaningful use” of a certified electronic health 

record (EHR) system (1,2). EHR systems that meet the meaningful use criteria 

have specific capabilities associated with efficient and high-quality patient 

care (3). Since enactment of the HITECH Act, nationally representative data 

about physician experiences with EHRs have been limited (4,5). This report 

describes physician experiences with EHRs, comparing clinical and financial 

indicators between physicians with and without EHR systems that meet 

meaningful use criteria.

Keywords: health information technology • National Ambulatory Medical 

Care Survey

How common are EHR systems that meet meaningful use 

criteria in physician practices?

• About three-quarters of EHR adopters (76%) report that they have a 

system that meets the Centers for Medicare & Medicaid Services (CMS) 

Figure 1. Percentage of physicians with electronic health record systems that meet meaningful 

use criteria: United States, 2011

NOTES: Data represent office-based physicians with electronic health record systems (n = 1,793). Missing responses (less than 

2%) were excluded. Meaningful use criteria were approved by the federal Centers for Medicare & Medicaid Services. The sample 

includes nonfederal, office-based physicians and excludes anesthesiologists, radiologists, and pathologists. Percentages may not 

sum to 100 because of rounding.

SOURCE: CDC/NCHS, National Ambulatory Medical Care Survey's Physician Workflow Survey, 2011.

Does not meet

8

Uncertain

15 Meets

76
NCHS Data Brief ■ No. 129 ■ September 2013

■  2  ■

meaningful use criteria, whereas 8% have a system that does not meet the meaningful use 

criteria. About 15% of respondents are uncertain whether their system meets the meaningful 

use criteria (Figure 1).

Are physicians who have EHR systems that meet meaningful use criteria 

more likely to report time savings?

Figure 2. Percentage of physicians using electronic health record systems who report agreement with selected efficiency 

indicators, by whether the systems meet meaningful use criteria: United States, 2011

1

Differences between physicians with systems that meet meaningful use criteria and those with systems not meeting these criteria were significant (p < 0.05). 

NOTES: EHR is electronic health record. Data represent office-based physicians with EHR systems (n = 1,793). Missing responses (less than 6%) were excluded 

for each of the items. 

SOURCE: CDC/NCHS, National Ambulatory Medical Care Survey's Physician Workflow Survey, 2011.

Percent

EHR does not

meet meaningful

use criteria or

uncertain

EHR meets 

meaningful use

criteria

0 20 40 60 80 100

Amount of time spent responding

to pharmacy calls increased

My practice receives

laboratory results faster

Amount of time spent to plan,

review, order, and document 

care has increased

Sending prescriptions

electronically saves me time

1

82

67

76

78

1

75

61

28

34

• Eighty-two percent of physicians with an EHR system that meets meaningful use criteria 

agree that electronic prescribing saves them time, compared with 67% of physicians whose 

EHR system did not meet meaningful use criteria (Figure 2).

• Seventy-five percent of physicians with an EHR system that meets meaningful use criteria 

agree that their practice receives laboratory results faster, compared with 61% of physicians 

whose EHR system did not meet meaningful use criteria (Figure 2).

• Approximately one-third of physicians with an EHR system judged that it increases the 

time taken to answer pharmacy calls, regardless of whether the system met meaningful use 

criteria (Figure 2).

• Regardless of whether their EHR system met meaningful use criteria, over three-quarters of 

these physicians reported that the amount of time taken to plan, review, order, and document 

care has increased due to using the system (Figure 2).
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Are physicians who have EHR systems that meet meaningful use criteria 

more likely to report clinical and financial benefits?

Figure 3. Percentage of physicians using electronic health record systems who report agreement with selected clinical and 

financial benefits indicators, by whether the system meets meaningful use criteria: United States, 2011

1

Differences between physicians with systems that meet meaningful use criteria and those with systems not meeting these criteria were significant (p < 0.05). 

NOTES: EHR is electronic health record. Data represent office-based physicians with EHR systems (n = 1,793). Missing responses (less than 6%) were excluded 

for each of the items. 

SOURCE: CDC/NCHS, National Ambulatory Medical Care Survey's Physician Workflow Survey, 2011.

Percent of EHR adopters

0 20 40 60 80 100

EHR does not

meet meaningful

use criteria or

uncertain

EHR meets 

meaningful use

criteria

Billing for services is less complete

My EHR disrupts the way

I interact with my patients

My EHR enhances data confidentiality

My EHR allows me to deliver

better patient care

My EHR makes records more readily

available at the point of care

My practice saves on costs

associated with managing and

storing paper records

Financial benefits

Clinical benefits

94

91

75

69

1

70

60

1

50

61

75

72

22

18

• Sixty-one percent of physicians with an EHR system not meeting meaningful use criteria 

believed that it disrupts the way they interact with patients, compared with 50% of 

physicians with an EHR system that meets meaningful use criteria (Figure 3).

• Seventy percent of physicians with an EHR system that meets meaningful use criteria 

agreed that their system enhances patient data confidentiality, compared with 60% of 

physicians whose EHR system did not meet the criteria (Figure 3). 

• Physicians with an EHR system largely agreed that the system makes records more readily 

available at the point of care (94% meeting meaningful use, 91% not meeting meaningful 

use), and allows them to deliver better patient care (75% meeting meaningful use, 69% not 

meeting meaningful use), regardless of whether the system met the CMS criteria (Figure 3).

• Almost three-quarters of physicians with an EHR system (75% meeting meaningful use, 

72% not meeting meaningful use) judged that it saves on costs associated with managing 

and storing paper records, regardless of whether the system met meaningful use criteria 

(Figure 3).
NCHS Data Brief ■ No. 129 ■ September 2013

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Summary

Based on nationally representative data, about three-quarters of physicians with an EHR system 

have a system that meets federal Stage 1 Meaningful Use Criteria. 

Physicians with EHR systems meeting these criteria believed that the systems provide some timesaving practice efficiencies, such as receiving laboratory results faster and enabling electronic 

prescribing, compared with systems not meeting meaningful use criteria. In addition, physicians 

using an EHR system that meets meaningful use criteria were less likely to perceive their 

system as disrupting the way they interact with patients than those using a system not meeting 

the criteria. Moreover, physicians with an EHR system that meets meaningful use criteria were 

more likely to agree that the system enhanced data confidentiality, compared with those having a 

system not meeting the criteria.

A majority of physicians judged their EHR system to have various clinical effects, financial 

benefits, and some efficiencies, regardless of whether their system met the meaningful use 

criteria. Clinical benefits perceived among EHR system users included the availability of 

records at the point of care, and the ability to deliver better patient care due to using the system. 

However, at least one-half of physicians with an EHR system believed that it disrupts the way 

they interact with patients. A majority of physicians considered their EHR system as providing 

specific financial benefits, such as allowing them to save on costs associated with managing and 

storing paper records, and resulting in at least the same or more complete billing. A majority of 

physicians with EHR systems also believed that their system provided practice efficiencies, such 

as receiving laboratory results faster, saving time with electronic prescribing, and spending at 

least the same or less time responding to pharmacy calls. However, most physicians with an EHR 

system experienced an increase in time spent planning, reviewing, ordering, and documenting 

care. A majority of physicians with EHR systems judged them as enhancing data confidentiality.

These survey findings provide insight into the effects of using EHR systems since the 2009 

enactment of HITECH. The findings indicate common challenges of using EHR systems, 

including increased time spent documenting care and the disruption of patient interactions. The 

findings suggest that most physicians have experienced various clinical and financial benefits, as 

well as practice efficiencies, from using EHR systems, with physicians using an EHR system that 

meets meaningful use criteria reporting greater specific time-saving benefits.

Definitions 

Physician office: A place where physicians who are not federally employed provide direct patient 

care, within the 50 states and the District of Columbia; excludes radiologists, anesthesiologists, 

and pathologists.

System meets/does not meet meaningful use criteria: Meaningful use in this report was 

determined based on whether a respondent’s EHR was certified to meet the U.S. Department of 

Health and Human Services’ Stage 1 Meaningful Use Criteria. This variable was created based 

on responses to the question, “Does your current system meet Meaningful Use criteria, as defined 

by the Centers for Medicare & Medicaid Services (CMS)?” Response categories were “yes,” 

“no,” and “uncertain.” Physicians who answered yes were considered to use an EHR system that 

meets meaningful use criteria. To qualify for the CMS incentive payments for meaningful use, an 
NCHS Data Brief ■ No. 129 ■ September 2013

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eligible provider must use a certified EHR system demonstrating all 15 of the core set objectives 

and 5 of 10 menu set objectives through associated measures or by attestation in 2011 (2). A 

system not meeting these criteria was defined as physicians answering “no” or “uncertain,” or a 

missing response (less than 2%).

EHR adopters: Derived from office-based physicians who answered the National Ambulatory 

Medical Care Survey (NAMCS) Electronic Medical Records mail survey question, “Does the 

reporting location use an electronic medical record (EMR) or electronic health record (EHR) 

system? Do not include billing record systems.” Adopters are those who answered either “yes, all 

electronic” or “yes, part paper and part electronic,” whereas nonadopters answered “no” to using 

EMR or EHR systems.

Benefits of an EHR: Physician perceptions were calculated from their responses to questions 

that asked whether they agree with statements about using EHRs. Response categories were: 

“strongly agree,” “somewhat agree,” “somewhat disagree,” and “strongly disagree” (6,7). Both 

sets of agreement and disagreement responses were combined, creating dichotomous variables of 

agree and disagree. Missing responses represented 1%–6% of physicians. Item nonresponse may 

indicate that a specific benefit was not applicable to the physician’s scope of work or role in the 

practice. 

Data source and methods

The data for this report come from the NAMCS Physician Workflow Survey and include 

physicians who have adopted an EHR system. The Physician Workflow Survey, funded by the 

Office of the National Coordinator for Health Information Technology, is conducted by the 

Centers for Disease Control and Prevention’s National Center for Health Statistics (NCHS). It 

represents a 3-year initiative to survey office-based physicians about their experiences with and 

perceptions of adopting and using an EHR system. Respondents are followed annually over a 

3-year period, from 2011 through 2013. More detailed information about the study design is 

provided in an earlier report (4). 

The sample consisted of those physicians confirmed eligible (i.e., seeing ambulatory patients in a 

physician’s office) and answering the question about EHR use (see Definitions–EHR adopters) in 

the earlier 2011 NAMCS EMR mail survey (8). Eligible physicians for whom adoption status was 

not confirmed in the EMR survey were contacted to determine that status. Only eligible NAMCS 

respondents were mailed a Physician Workflow Survey questionnaire within a 2-month period 

of determining whether they used a system. Adopters received a different questionnaire from 

nonadopters (6,7). For this report, nationally weighted estimates are presented for 1,793 EHR 

adopters from the 2011 physician workflow mail survey. 

All comparisons reported in the text are statistically significant unless otherwise indicated. 

Comparisons not mentioned may or may not be statistically significant. Data analyses were 

performed using the statistical packages SAS version 9.2 (SAS Institute, Cary, N.C.) and 

SUDAAN version 10.0 (RTI International, Research Triangle Park, N.C.)
NCHS Data Brief ■ No. 129 ■ September 2013

■  6  ■

About the authors 

Eric Jamoom is with the Centers for Disease Control and Prevention’s National Center for Health 

Statistics, Division of Health Care Statistics. Vaishali Patel, Jennifer King, and Michael Furukawa 

are with the U.S. Department of Health and Human Services’ Office of the National Coordinator 

for Health Information Technology, Office of Economic Analysis, Evaluation, and Modeling.

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. The official Web site for the Medicare & 

Medicaid EHR incentive programs. Available from: https://www.cms.gov/ehrincentiveprograms/

[Accessed August 1, 2013]. 

3. Buntin MB, Jain SH, Blumenthal D. Health information technology: Laying the infrastructure 

for national health reform. Health Aff (Millwood) 29(6):1214–9. 2010.

4. Jamoom E, Beatty P, Bercovitz A, et al. Physician adoption of electronic health record 

systems: United States, 2011. NCHS data brief, no 98. Hyattsville, MD: National Center for 

Health Statistics. 2012.

5. DesRoches CM, Campbell EG, Rao SR, Donelan K, Ferris TG, Jha A, et al. Electronic health 

records in ambulatory care—A national survey of physicians. N Engl J Med 359(1):50–60. 2008. 

6. National Center for Health Statistics. Physician workflow supplement 2011 [EHR adopters], 

National Ambulatory Medical Care Survey. 2011. Available from: http://www.cdc.gov/nchs/

data/ahcd/2011_Physician_Workflow_Supplement_for_EHR_Adopters.pdf [Accessed August 1, 

2013].

7. National Center for Health Statistics. Physician workflow supplement 2011 [EHR 

nonadopters], National Ambulatory Medical Care Survey. 2011. Available from: http://www.

cdc.gov/nchs/data/ahcd/2011_Physician_Workflow_Supplement_for_EHR_Non-Adopters.pdf

[Accessed August 1, 2013].

8. National Center for Health Statistics. Electronic medical records supplement 2011, National 

Ambulatory Medical Care Survey. 2011. Available from: http://www.cdc.gov/nchs/data/

ahcd/2011_EMR_Survey.pdf [Accessed August 1, 2013].
NCHS Data Brief ■ No. 129 ■ September 2013

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NCHS Data Brief ■ No. 129 ■ September 2013

U.S. DEPARTMENT OF

HEALTH & HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics

3311 Toledo Road, Room 5419

Hyattsville, MD 20782

OFFICIAL BUSINESS 

PENALTY FOR PRIVATE USE, $300

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Suggested citation

Jamoom E, Patel V, King J, Furukawa MF. 

Physician experience with electronic health 

record systems that meet meaningful use 

criteria: NAMCS Physician Workflow 

Survey, 2011. NCHS data brief, no 129. 

Hyattsville, MD: National Center for Health 

Statistics. 2013.

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., Acting Director

Jennifer H. Madans, Ph.D., Associate 

Director for Science

Division of Health Care Statistics

Clarice Brown, M.S., Director

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ISSN 1941–4927 Print ed.

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DHHS Publication No. 2013–1209

CS 243145