NCHS Data Brief ■ No. 79 ■ November 2011

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics

Electronic Health Record Systems and Intent to Apply for 

Meaningful Use Incentives Among Office-based

Physician Practices: United States, 2001–2011

Chun-Ju Hsiao, Ph.D.; Esther Hing, M.P.H.; Thomas C. Socey; and Bill Cai, M.A.Sci.

Key findings

Data from the National 

Ambulatory Medical Care 

Survey

• In 2011, 57% of office-based 

physicians used electronic 

medical record/electronic 

health record (EMR/EHR) 

systems, with use by state 

ranging from 40% in Louisiana 

to 84% in North Dakota.

• About one-third of 

physicians (34%) reported 

having a system that met the 

criteria for a basic system, 

ranging by state from 16% 

in New Jersey to 61% in 

Minnesota.

• In 2011, 52% of physicians 

reported intending to apply for 

meaningful use incentives, up 

from 41% in 2010.

• In 2010, 43% of physicians 

planning to apply for 

meaningful use incentives had 

computerized systems that 

would allow them to meet eight 

Stage 1 Core Set objectives, 

with percentages by state 

ranging from 26% in Texas to 

70% in Wisconsin.

The 2009 Health Information Technology for Economic and Clinical Health 

(HITECH) Act authorized incentive payments through Medicare and Medicaid 

to increase physician adoption of electronic health record (EHR) systems (1,2). 

Eligible Medicare and Medicaid physicians may receive incentive payments 

over 5 years if they demonstrate 15 Stage 1 Core Set objectives and 5 of 10 

Menu Set objectives, using certified EHR systems. This report describes 

trends in adoption of electronic medical record/electronic health record (EMR/

EHR) systems through 2011 and provides baseline information on physician 

readiness to meet eight Stage 1 Core “meaningful use” objectives in 2010 (see 

“Definitions” section for an overview of meaningful use objectives). Data 

are reported from 2010 and 2011 mail surveys of physicians in the National 

Ambulatory Medical Care Survey (NAMCS) and in earlier years of the survey.

Keywords: health information technology • National Ambulatory Medical 

Care Survey

Adoption of EMR/EHR systems by office-based physicians 

has increased.

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

2001–2009, and preliminary 2010–2011

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 the in-person National 

Ambulatory Medical Care Survey (NAMCS). Data for 2008–2009 are from combined files (in-person NAMCS and mail survey). 

Data for 2010–2011 are preliminary estimates (dashed lines) based on the mail survey only. Estimates through 2009 include 

additional physicians sampled from community health centers. 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.

Any EMR/EHR system

Basic

EMR/EHR 

system

18.2 17.3 17.3

20.8

10.5 11.8

16.9

21.8 24.9

33.9

23.9

29.2

34.8

42.0

48.3 50.7

57.0

Percent of physicians

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

0

10

20

30

40

50

60

This report was revised on February 8, 2012, after a problem was found with the weighting of the 2011 survey data.
NCHS Data Brief ■ No. 79 ■ November 2011

■  2  ■

• EMR/EHR system use among office-based physicians increased from 18% in 2001 to 57% in 

preliminary 2011 estimates; there was a 12% increase from the 2010 estimate (51%) (Figure 1).

• About 34% of physicians reported having a system that met the criteria for a basic system, a 

36% increase from 2010 (25%). 

• Preliminary 2011 estimates from the NAMCS mail survey showed that the percentage of 

physicians using any EMR/EHR system, by state, ranged from 40% in Louisiana to 84% in North 

Dakota (see Table).

Table. Percentages of office-based physicians using any EMR/EHR system (2011), having a basic system (2011), and

planning to apply for meaningful use incentives (2010), by state

State Any 

system

Basic 

system

Plan to 

apply State Any 

system 

Basic 

system

Plan to 

apply

Percent Percent

United States 57.0 33.9 41.1 Missouri 57.0 32.9 39.6

Alabama 47.3 25.8 49.6 Montana 62.3 38.3 34.5

Alaska 59.2 29.5 29.0† Nebraska 58.5 35.6 44.1

Arizona 66.7 37.0 41.7 Nevada 52.5 23.0† 41.7

Arkansas 51.2 24.5 50.3 New Hampshire 68.1§ 38.1 41.3

California 58.6 40.4 40.1 New Jersey 41.8† 16.3† 40.8

Colorado 65.8 36.0 49.1 New Mexico 54.1 27.8 38.4

Connecticut 61.9 31.5 38.1 New York 55.3 34.6 28.0†

Delaware 59.5 36.5 47.3 North Carolina 58.0 31.1 34.2

District of Columbia 65.3 21.2† 21.0† North Dakota 84.0§ 57.9§ 29.7†

Florida 48.5 28.4 43.4 Ohio 58.9 31.6 35.7

Georgia 58.3 31.1 44.8 Oklahoma 54.7 28.2 47.2

Hawaii 71.0§ 46.8§ 35.5 Oregon 75.1§ 54.5§ 44.0

Idaho 52.6 24.5† 45.7 Pennsylvania 50.6 27.3 47.5

Illinois 53.7 28.2 37.2 Rhode Island 43.8† 29.2 46.7

Indiana 57.7 34.3 47.7 South Carolina 53.4 19.5† 44.0

Iowa 73.1§ 48.6§ 49.2 South Dakota 55.4 41.2 45.9

Kansas 61.2 30.9 50.3 Tennessee 48.2 28.6 38.4

Kentucky 46.0 28.5 51.0 Texas 52.4 33.9 38.4

Louisiana 39.5† 15.9† 39.3 Utah 80.8§ 49.3§ 49.1

Maine 62.5 33.3 42.7 Vermont 66.8§ 35.7 38.8

Maryland 52.7 30.6 38.9 Virginia 59.5 29.1 45.2

Massachusetts 71.2§ 43.6 45.5 Washington 75.3§ 54.6§ 44.2

Michigan 51.9 29.5 51.3 West Virginia 52.9 28.2 29.0†

Minnesota 77.6§ 60.9§ 40.1 Wisconsin 75.8§ 59.9§ 41.5

Mississippi 54.3 19.9† 49.2 Wyoming 50.6 27.2 37.2

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

NOTE: EMR/EHR is electronic medical record/electronic health record.

SOURCE: CDC/NCHS, National Ambulatory Medical Care Survey.
NCHS Data Brief ■ No. 79 ■ November 2011

■  3  ■

• Compared with the national average (57%), the percentage of physicians using any EMR/

EHR system was lower in 3 states (Louisiana, New Jersey, and Rhode Island) and higher in 11 

states (Hawaii, Iowa, Massachusetts, Minnesota, New Hampshire, North Dakota, Oregon, Utah, 

Vermont, Washington, and Wisconsin). 

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

ranged from 16% in New Jersey to 61% in Minnesota.

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

lower in the District of Columbia and six states (Idaho, Louisiana, Mississippi, Nevada, New 

Jersey, and South Carolina) and higher in eight states (Hawaii, Iowa, Minnesota, North Dakota, 

Oregon, Utah, Washington, and Wisconsin) compared with the national average. 

Intent to apply for Medicare or Medicaid EHR incentive programs increased 

between 2010 and 2011.

• In 2011, 52% of physicians reported intending to apply for Medicare or Medicaid EHR 

incentive payments, a 26% increase from 2010 (Figure 2). 

• In 2010, the percentage of physicians planning to apply for incentives was lower than the 

national average (41%) in four states (Alaska, New York, North Dakota, and West Virginia) and 

the District of Columbia (see Table).

0

10

20

30

40

50

60

Uncertain Not applying Plan to apply1 1

Figure 2. Office-based physicians’ intent to apply for Medicare or Medicaid EHR incentive program: United States, 

preliminary 2010–2011

1

Differences between 2010 and 2011 percentages are statistically significant (p < 0.05).

NOTES: Data are obtained from responses to the question, “Beginning in 2011, Medicare and Medicaid will offer incentives to practices that demonstrate 

‘meaningful use of Health IT.’ At this practice, are there plans to apply for Medicare or Medicaid incentive payments for meaningful use of Health IT?” Data include 

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

SOURCE: CDC/NCHS, National Ambulatory Medical Care Survey. Percent of physicians

2010 2011

41.1

51.8

44.9

32.9

14.0 15.3

In 2010, 4 in 10 physicians planning to apply for meaningful use incentive 

payments had computerized systems that would allow them to meet eight 

Stage 1 Core Set meaningful use objectives.

• Among physicians planning to apply for meaningful use incentives, 43% had computerized 

systems supporting eight Stage 1 Core Set objectives (Figure 3 and “Definitions”). 

• Readiness in eight Stage 1 Core Set objectives among physicians planning to apply for 

meaningful use incentives ranged from 26% in Texas to 70% in Wisconsin (Figure 3).
NCHS Data Brief ■ No. 79 ■ November 2011

■  4  ■

• Among physicians planning to apply for meaningful use incentives, the percentage with 

systems that would allow them to meet eight Stage 1 Core Set meaningful use objectives 

exceeded the national average (43%) in eight states (Iowa, Maine, Massachusetts, Minnesota, 

Oregon, Utah, Washington, and Wisconsin).

• Among physicians planning to apply for meaningful use incentives, the percentage of 

physicians with systems that would allow them to meet eight Stage 1 Core Set meaningful use 

measures was lower than the national average only in Texas (26%).

DC

47.2

MT

34.6

WY

50.3

ID

51.1

WA

63.6

OR

65.5

NV

54.0 UT

60.0 CA

34.0

AZ

43.6

ND

44.4

SD

41.6

NE

40.3

CO

51.0

NM

52.8

TX

25.6

OK

37.3

KS

42.0

AR

52.4

LA

30.1

MO

56.7

IA

62.7

MN

61.6

WI

70.4

IL

41.2

IN

40.6

KY

38.8

TN

40.1

MS

44.0

AL

42.7

GA

30.3

FL

23.4

SC

44.8

NC

36.5

VA

57.9

WV

53.2

OH

51.3

MI

48.9

NY

46.2

PA

46.2

MD

35.5

DE 52.8

NJ 30.5

CT 50.2

RI 39.0

MA 65.9

ME

62.0 VT

45.9

NH 54.7

AK

51.7

HI

55.6

National average 

is 43.1%

Figure 3. Percentage of office-based physicians planning to apply for meaningful use incentives who have EHR system 

capabilities to support eight Stage 1 Core Set meaningful use objectives, by state: United States, 2010

NOTE: EHR is electronic health record.

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

Not significantly 

different

Significantly 

higher

Significantly 

lower

Percentage does not meet standards 

of reliability or precision

Percentage potentially able to meet meaningful use core criteria compared with national average:

Summary

An increasing trend in EMR/EHR system use among office-based physicians was noted from 

2001 through preliminary 2011 estimates. In 2011, the NAMCS mail survey showed about 57% 

of office-based physicians used any EMR/EHR system, a 12% increase from the 2010 estimate. 

Between 2010 and 2011, the percentage of physicians who reported having systems meeting the 

criteria for a basic system increased 36%. 

Adoption of EMR/EHR systems varied greatly by state. In 2011, the percentage of physicians 

using any EMR/EHR system ranged from 40% in Louisiana to 84% in North Dakota. Compared 

with the national average, 3 states had a significantly lower percentage of office-based physicians 

using any EMR/EHR system, and 11 states had a significantly higher percentage. The percentage 

of physicians having a system that met the criteria for a basic system ranged from 16% in New 
NCHS Data Brief ■ No. 79 ■ November 2011

■  5  ■

Jersey to 61% in Minnesota. Compared with the national average, six states had a significantly 

lower percentage of office-based physicians with a basic system, and eight states had a 

significantly higher percentage. 

In 2011, 52% of physicians reported intending to apply for the Medicare or Medicaid EHR 

incentive payments, a 26% increase from 2010. In 2010, interest among physicians in applying 

for meaningful use incentive payments was similar to the national average (41%) across most 

states. In only four states (Alaska, New York, North Dakota, and West Virginia) and the District 

of Columbia was the percentage lower than the national average.

To qualify for Stage 1 meaningful use incentive payments, eligible physicians need to meet all 

15 Stage 1 Core Set objectives and 5 of 10 Menu Set objectives, using certified EHR systems 

(see “Definitions”). In this report, estimates of physicians’ readiness to meet Stage 1 Core Set 

meaningful use measures were limited to data collected on the computerized functions needed 

to meet eight Stage 1 objectives. A previous study found that 15% of physicians eligible to 

apply for meaningful use incentives had EHR systems with basic functions capability (3). In 

the present study, 43% of physicians planning to apply for incentives had EHR systems with 

functions that would allow them to meet eight Stage 1 Core Set meaningful use objectives. In 

2010, the percentage of physicians planning to apply for incentives with EHR systems able to 

support eight Stage 1 Core Set objectives exceeded the national average in eight states (Iowa, 

Maine, Massachusetts, Minnesota, Oregon, Utah, Washington, and Wisconsin) and was below the 

national average only in Texas.

The 2010 estimates represent an overestimate of physician readiness because not all physicians 

with systems supporting all eight objectives examined in this report have systems also capable of 

supporting the remaining seven Core Set objectives and 5 of 10 Menu Set objectives required for 

payment. 

As federal programs to provide incentives for meaningful use and local technical support are 

implemented, monitoring EHR system adoption will continue to be important in evaluating the 

effectiveness of these policies and targeting efforts in certain areas.

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 of all of the following functionalities: patient history 

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

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

and imaging results electronically (4). Having a comprehensive list of patient’s medications and 

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

allergies); the questions were collapsed into one question in 2011 (5).
NCHS Data Brief ■ No. 79 ■ November 2011

■  6  ■

Demonstrating meaningful use: To qualify for Stage 1 meaningful use incentives, an eligible 

professional (EP) must use a certified EHR system “meaningfully” by demonstrating all 15 Core 

Set objectives and 5 of 10 Menu Set objectives through associated measures or by attesting to 

an objective (1). For example, EPs 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, EPs who 

have implemented 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 has been 

published elsewhere (1,2). Following is a crosswalk of Stage 1 meaningful use objectives and 

applicable EHR system functions reported in the 2010 NAMCS:

Meaningful Use Objectives 2010 NAMCS

Core set Physician has computerized system for:

Computerized provider order entry for medications Prescription order entry

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

Generate and transmit permissible prescriptions

electronically

Sending prescription orders electronically to the

pharmacy

Record patient demographics Patient history and demographic information

Maintain up-to-date problem list of current and active

diagnoses

Patient problem list

Maintain active medication list Clinical notes include a list of current medications

Maintain active medication allergy list Comprehensive list of the patient’s allergies

Vital signs ...

Smoking status ...

Implement one clinical decision support rule and ability to

track compliance with rule

Reminders provided for guideline-based interventions

or screening tests, or warnings of drug interactions or 

contraindications

Calculate and transmit Centers for Medicare & Medicaid 

Services quality measure

...

Electronic copy of health information ...

Clinical summaries ...

Exchange key clinical information ...

Privacy/security ...

Menu set Physician has computerized system for:

Implement drug formulary checks ...

Incorporate clinical laboratory test results into EHR

system as structured data

Laboratory results incorporated into EHR system

Patient lists ...

Patient reminders ...

Timely electronic access to health information ...

Patient-specific information ...

Medication reconciliation ...

Summary of care ...

Submit electronic immunization data to registries or 

information systems

Electronic reporting to immunization registries

Submit laboratory results to public health agencies ...

Submit electronic syndromic surveillance data to public

health agencies

Public health reporting for notifiable diseases sent

electronically

... Data not available. 

NOTE: EHR is electronic health record.
NCHS Data Brief ■ No. 79 ■ November 2011

■  7  ■

Data source and methods

Data for this report are from NAMCS, which is conducted by the Centers for Disease Control 

and Prevention’s (CDC) National Center for Health Statistics (NCHS) as 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 is physicians classified as 

providing direct patient care in office-based practices, including 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 2011 

ask a physician’s intent to apply for meaningful use incentive payments. 

The preliminary 2010 and 2011 estimates are from the NAMCS mail surveys, with a sample of 

10,301 physicians selected in each year. Nonrespondents to the mail survey received follow-up 

telephone calls. The 2010 mail survey was conducted from April through July 2010, and the 

2011 mail survey was conducted from February through June 2011. The unweighted response 

rates of the 2010 and 2011 mail surveys were 68% (66% weighted) and 64% (61% weighted), 

respectively. Copies of the 2010 and 2011 surveys are available from the NCHS website: 

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

Estimates of intent to apply for incentives exclude about 1% of cases with missing information. 

Estimates of physician readiness for Stage 1 Core Set objectives include physicians whose 

systems have all of the following eight computerized functions: recording patient demographic 

information, recording current problems, recording medications, recording patient allergies, 

CPOE for medications, sending prescriptions electronically to the pharmacy, providing drug-drug 

and drug-allergy alerts, and having at least one clinical decision support rule implemented. In this 

report, the percentage of physicians who had systems that would allow them to meet eight Stage 1 

Core Set meaningful use objectives excludes unknowns.

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

The authors are with CDC’s National Center for Health Statistics, Division of Health Care 

Statistics. Chun-Ju Hsiao and Esther Hing are with the Ambulatory and Hospital Care Statistics 

Branch. Thomas Socey and Bill Cai are with the Technical Services Branch.
NCHS Data Brief ■ No. 79 ■ November 2011

References 

1. Centers for Medicare & Medicaid Services. Official Web site for the 

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. Bruen BK, Ku L, Burke MF, Buntin MB. More than four in five officebased physicians could qualify for federal electronic health record incentives. 

Health Aff (Millwood) 30(3):472–80. 2011.

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

2008. Robert Wood Johnson Foundation. 2008. 

5. Hsiao CJ, Hing E, Socey TC, Cai B. Electronic medical record/electronic 

health record systems of office-based physicians: United States, 2009 and 

preliminary 2010 state estimates. Health E-Stats. National Center for Health 

Statistics. 2010. Available from: http://www.cdc.gov/nchs/data/hestat/emr_

ehr_09/emr_ehr_09.pdf.

Suggested citation

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.

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., Acting Director

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