This report was revised on January 11, 2013, after a problem was found with the weighting of the 2011 survey data.

NCHS Data Brief ■ No. 98 ■ July 2012

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics

Physician Adoption of Electronic Health Record Systems: 

United States, 2011

Eric Jamoom, Ph.D., M.P.H., M.S.; Paul Beatty, Ph.D.; Anita Bercovitz, Ph.D., M.P.H.;

David Woodwell, M.P.H.; Kathleen Palso, M.A.; and Elizabeth Rechtsteiner, M.S.

Key findings

Data from the 2011 

Physician Workflow study

• In 2011, 54% of physicians 

had adopted an electronic 

health record (EHR) system.

• About three-quarters of 

physicians who have adopted 

an EHR system reported that 

their system meets federal 

“meaningful use” criteria.

• Eighty-five percent of 

physicians who have adopted 

an EHR system reported being 

somewhat (47%) or very (38%) 

satisfied with their system. 

• About three-quarters of 

adopters reported that using 

their EHR system resulted in 

enhanced patient care. 

• Nearly one-half of 

physicians currently without an 

EHR system plan to purchase 

or use one already purchased 

within the next year.

One goal of the federal 2009 Health Information Technology for Economic 

and Clinical Health (HITECH) Act is to advance the use of health information 

technology by providing Medicare and Medicaid incentives to physicians and 

hospitals that adopt and demonstrate “meaningful use” (MU) of electronic 

health record (EHR) systems (1,2). This report presents a nationally 

representative profile of physician use of EHR systems.

Keywords: electronic health records • health information technology • 

National Ambulatory Medical Care Survey • physician workflow

Who adopts EHR systems?

• Fifty-four percent of physicians were adopters of EHR systems (see 

“Definitions”). Among physicians under age 50, 64% were adopters. 

Figure 1. Percentage of electronic health record system adoption, by physician age and 

specialty and practice size and ownership, 2011

0 20 40 60 80 100

Medical 

Surgical 

Primary care 

Academic health center

Community health center

HMO

Physician owned

11 or more physicians

3-10 physicians

2 physicians

Solo practitioner

Aged 50 and over

Under age 50

All physicians

Percent

Physician age

Practice size

Ownership

Physician specialty

54

1

64

1

49

1

29

60

62

1

86

1

49

1

100

73

69

2

48

54

2

58

1

Differences in adoption between this category and all others are statistically significant (p < 0.01). 2

Significant difference between primary care and surgical specialists (p < 0.01).

NOTES: Adoption consists of physicians who use a health record system that is all or partially electronic (excluding systems 

solely for billing). The sample includes nonfederal, office-based physicians and excludes radiologists, anesthesiologists, and 

pathologists. HMO is health maintenance organization.

SOURCE: CDC/NCHS, Physician Workflow study, 2011.
NCHS Data Brief ■ No. 98 ■ July 2012

■  2  ■

About one-half of physicians aged 50 and over were adopters (Figure 1). 

• Among solo practitioners, 29% were adopters of EHR systems. The proportion of 

physicians who were adopters increased as the size of the practice increased, with 60% of 

physicians in 2-physician practices, 62% of physicians in 3-to-10-physician practices, and 

86% of physicians in practices with 11 or more physicians having adopted EHR systems 

(Figure 1). 

• Only 49% of physicians in physician-owned practices were adopters, whereas virtually 

all physicians in health maintenance organizations, about three-quarters of physicians in 

community health centers (73%), and 7 out of 10 physicians (69%) in academic health 

centers had adopted EHR systems (Figure 1).

• Primary care (58%) and medical care specialists (54%) did not significantly differ from 

each other in EHR adoption, yet a greater proportion of primary care specialists had adopted 

EHR systems compared with surgical specialists (48%) (Figure 1). 

• No differences were observed in EHR adoption status by physician gender, race or ethnicity, 

or practice location in metropolitan statistical area (data not shown).

What kinds of systems do EHR adopters use? 

• About three-quarters of adopters (76%) have a system that currently meets the Centers for 

Medicare & Medicaid Services (CMS) MU criteria (see “Definitions”), whereas 8% have 

a system that does not meet the CMS MU criteria. About 15% of respondents are uncertain 

whether their system meets MU criteria (Figure 2). 

0 20 40 60 80

59

41

76

8

15

100

Uncertain

Does not meet 

Meets 

Meaningful use

 criteria3

System design

Web-based2

Stand-alone1

Percent of physicians with EHR4

 systems

Figure 2. Physicians’ electronic health record systems, by type and ability to meet meaningful use criteria, 2011

1

Data and application functionality delivered on-site. 2

System hosted and data stored off-site. 3

Defined by Centers for Medicare & Medicaid Services. 4

Electronic health record. 

NOTES: Data represent physicians who reported having adopted EHR systems (55% of sample). The sample includes nonfederal, office-based physicians

and excludes radiologists, anesthesiologists, and pathologists. Missing values are excluded. Percentages may not sum to 100 because of rounding. 

SOURCE: CDC/NCHS, Physician Workflow study, 2011.
NCHS Data Brief ■ No. 98 ■ July 2012

■  3  ■

• More adopters have a stand-alone, self-contained, system (59%) rather than a Web-based 

design system (41%) (see “Definitions”) (Figure 2).

• Although 10% of adopters were in the process of implementing their EHR system, the vast 

majority of adopters (90%) reported actively using their EHR system (data not shown). 

How satisfied are EHR users with their systems? 

• The majority of physicians who have adopted an EHR system (85%) were either very 

satisfied (38%) or somewhat satisfied (47%) with their system. About 15% of providers 

were either very dissatisfied (5%) or somewhat dissatisfied (10%) with their EHR system 

(Figure 3). 

• Over two-thirds of adopters (71%) would purchase their EHR system again (data not 

shown). 

Figure 3. Percent distribution of electronic health record satisfaction among office-based physicians:

United States, 2011

NOTES: Data represent office-based physicians who reported having adopted electronic health record systems (55% of sample). The sample includes 

nonfederal, office-based physicians and excludes radiologists, anesthesiologists, and pathologists. Missing values are excluded. 

SOURCE: CDC/NCHS, Physician Workflow study, 2011.

Very dissatisfied

Somewhat

dissatisfied

Somewhat satisfied

Very satisfied

38

10

5

47
NCHS Data Brief ■ No. 98 ■ July 2012

■  4  ■

What are the benefits of having an EHR system? 

• A majority of adopters reported having accessed a patient’s chart remotely (74%) and 

having been alerted to critical lab values (52%) by using their EHR system within the past 

30 days. A majority also reported that using their EHR system had resulted in enhanced 

overall patient care (74%) (Figure 4).

Figure 4. Percentage of physicians whose electronic health records provided selected benefits: United States, 2011

NOTES: Physicians with electronic health record (EHR) systems whose systems or scope of work did not include a specified capability responded not 

applicable. These responses are included in the denominator for percentages. Data represent office-based physicians who reported having adopted EHR 

systems (55% of sample). The sample includes nonfederal, office-based physicians and excludes radiologists, anesthesiologists, and pathologists.

SOURCE: CDC/NCHS, Physician Workflow study, 2011.

0 20 40 60 80

Patient-related outcomes

Physician workflow

Percent of physicians who experienced benefit within

past 30 days

Ordered fewer tests due to lab results’ availability 30

Ordered more on-formulary medications 44

Enhanced overall patient care 74

Facilitated direct communication with patient 25

Identified needed lab tests 29

Reminded to provide care meeting clinical guidelines 38

Alerted to potential medication error 43

Reminded to provide preventive care 40

Alerted to critical lab value 52

Accessed patient chart remotely 74
NCHS Data Brief ■ No. 98 ■ July 2012

■  5  ■

Do physicians without an EHR system intend to purchase a system? 

• Among nonadopters, about one-third reported having no intention to purchase an EHR 

system within 12 months (32%), and one-fifth reported being undecided whether to purchase 

an EHR system in the next 12 months (20%). In addition, about one-half of nonadopters 

reported either intending to purchase an EHR system within 12 months (26%) or having 

already purchased one (21%) (Figure 5). 

Figure 5. Percent distribution of intent to purchase electronic health record system among physicians lacking a system: 

United States, 2011

NOTES: Data represent office-based physicians who reported not having adopted an electronic health record system (45% of sample). The sample includes

nonfederal, office-based physicians and excludes radiologists, anesthesiologists, and pathologists. Percentages may not sum to 100 because of rounding. 

SOURCE: CDC/NCHS, Physician Workflow study, 2011.

21

Have purchased

system

26

In process of

selecting system or

intend to purchase

within 12 months 20

Undecided on

purchasing within

12 months

32

No intent to

purchase within

12 months
NCHS Data Brief ■ No. 98 ■ July 2012

■  6  ■

Summary

Overall, in 2011, 54% of physicians in office-based practices had adopted EHRs and 46% had 

not. Differences were observed between physicians who were EHR adopters and nonadopters 

by age, physician specialty, practice size, and ownership. Generally, physicians under age 50 

were more likely to adopt EHR systems than physicians aged 50 and over. The proportion of 

physicians who were adopters increased as the size of the practice increased. Compared with solo 

practitioners where fewer than one-third of physicians adopted EHR systems, those in 2-physician 

or 3-to-10-physician practices were twice as likely, and those in practices with 11 or more 

physicians were nearly three times as likely, to have adopted EHR systems. Only one-half of 

those in physician-owned practices were adopters, whereas physicians employed by community 

health centers, academic health centers, and HMOs were more likely to have adopted an EHR 

system. 

The majority of EHR adopters’ systems met CMS MU criteria, which would allow the practice 

to receive incentive payments authorized by the HITECH Act. A majority of EHR adopters had 

stand-alone systems rather than Web-based systems. Stand-alone systems offer faster response 

times than Web-based systems, and although stand-alone systems have higher initial cost, their 

maintenance costs are lower. Web-based systems have the advantage of being easy to access 

wherever the Internet is available, whereas stand-alone systems may have limited off-site access. 

The vast majority of physicians who use EHR systems (85%) reported being somewhat satisfied 

(47%) or very satisfied (38%) with their system. A majority would purchase their EHR system 

again (71%), suggesting that EHR adopters are generally positive about their current systems. 

Among EHR adopters, 74% believe that using their system enhanced overall patient care. 

Among nonadopters, about one-half reported either already having purchased a system or 

planning to adopt a system within 12 months. This finding suggests an increase in EHR adoption 

is likely to take place in 2012 among 2011’s nonadopters, potentially amplifying the impact of 

federal policy incentives. 

Definitions 

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

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

pathologists.

Demonstrating meaningful use (MU): To qualify for CMS incentive payments for MU, an 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). Comparisons of 

several core objectives are available from the NAMCS supplemental EHR mail survey (3).

Adopters and nonadopters of EHRs: Status is derived from office-based physicians who answered 

the EMR supplement question, “Does this practice use electronic medical records or electronic 

health records (not including billing records)?” Adopters are those who answered either “yes, 

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

electronic medical records (EMRs) or EHRs.
NCHS Data Brief ■ No. 98 ■ July 2012

■  7  ■

Stand-alone and Web-based design EHR systems: A stand-alone, or client, server represents an 

EHR system that is self-contained, in which data and application functionality are delivered onsite. Web-based EHR systems include application service providers and browser-based systems, 

also called a “cloud system.” Web-based design EHR systems use a service provider to host the 

system and store data for the practice off-site, and the physician accesses the EHR system and 

data through the Internet (4). 

Data source and methods

The data for this report are from the National Ambulatory Medical Care Survey (NAMCS) 

Physician Workflow mail survey. The Physician Workflow study, funded by the Office of the 

National Coordinator for Health Information Technology, is conducted by the National Center 

for Health Statistics (NCHS) as a NAMCS supplement. It represents a 3-year initiative to survey 

office-based physicians about their experiences in and perceptions of adopting and using EHR 

systems. Respondents will be followed annually over a 3-year period, beginning in 2011 and 

continuing through 2013. 

The sample for the 2011 Physician Workflow mail survey consisted of those physicians confirmed 

eligible (i.e., who treat ambulatory patients in a physician’s office; see “Definitions”) in the 

earlier 2011 NAMCS EMR mail survey. The 2011 EMR mail sample was a stratified sample of 

physicians with strata defined by state. Eligible physicians for whom EHR adoption status was 

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

eligible respondents were mailed Physician Workflow questionnaires within a 2-month period of 

determining whether they used an EHR system. Adopters received a different questionnaire than 

nonadopters (4,5). 

Eligibility status was determined for 8,164 of the 10,301 office-based physicians in the EMR 

mail survey sample, for an unweighted eligibility status rate of 79.3% (77.7% weighted). Of these 

8,164 physicians, 5,232 were deemed eligible and mailed the Physician Workflow questionnaire, 

to which a total of 3,180 physicians responded for an unweighted response rate of 60.8% 

(59.0% weighted). The combined, overall unweighted response rate is based on multiplying the 

eligibility status rate by the workflow mail response rate among those deemed eligible. Therefore, 

the combined overall unweighted response rate is 48.2% (45.8% weighted). In order to be 

nationally representative and correct for nonresponse bias, survey weights were designed to use 

characteristics of late respondents (data obtained by phone) as a proxy for nonresponse. Those 

refusing to participate in the EMR survey were contacted to determine eligibility and included 

in the workflow survey if eligible. About 11% of workflow survey respondents had refused to 

participate in the EMR survey, with more of these respondents being nonadopters than adopters. 

For estimates from the EMR questionnaire (e.g., practice size or ownership), missing estimates 

include unit nonresponse among respondents who refused to take the EMR questionnaire. Among 

workflow survey respondents, the proportion that completed the EMR questionnaire was greater 

for EHR adopters than nonadopters.

All reported comparisons 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. 98 ■ July 2012

U.S. DEPARTMENT OF

HEALTH & HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics

3311 Toledo Road

Hyattsville, MD 20782

OFFICIAL BUSINESS 

PENALTY FOR PRIVATE USE, $300

FIRST CLASS MAIL 

POSTAGE & FEES PAID 

CDC/NCHS

PERMIT NO. G-284

About the authors 

The authors are with the Centers for Disease Control and Prevention’s 

National Center for Health Statistics, Division of Health Care Statistics. 

Eric Jamoom, Paul Beatty, Anita Bercovitz, and David Woodwell are with 

the Ambulatory and Hospital Care Statistics Branch; Kathleen Palso and 

Elizabeth Rechtsteiner are with the Technical Services Branch.

References

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

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

2. Centers for Medicare & Medicaid Services. The official Web site for the 

Medicare and Medicaid electronic health records (EHR) incentive programs. 

Available from: https://www.cms.gov/ehrincentiveprograms/ [Accessed April 

9, 2012]. 

3. 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. Available from: http://www.

cdc.gov/nchs/data/databriefs/db79.pdf [Accessed April 9, 2012].

4. Physician workflow supplement 2011 [EHR adopters], National 

Ambulatory Medical Care Survey. Hyattsville, MD: National Center for 

Health Statistics. 2011. Available from: http://www.cdc.gov/nchs/data/

ahcd/2011_Physician_Workflow_Supplement_for_EHR_Adopters.pdf 

[Accessed April 9, 2012].

5. Physician workflow supplement 2011 [EHR nonadopters], National 

Ambulatory Medical Care Survey. Hyattsville, MD: National Center for 

Health Statistics. 2011. Available from: http://www.cdc.gov/nchs/data/

ahcd/2011_Physician_Workflow_Supplement_for_EHR_Non-Adopters.pdf 

[Accessed April 9, 2012]

Suggested citation

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.

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

For e-mail updates on NCHS publication 

releases, subscribe online at: 

http://www.cdc.gov/nchs/govdelivery.htm.

For questions or general information

about NCHS:

Tel: 1–800–232–4636

E-mail: cdcinfo@cdc.gov

Internet: http://www.cdc.gov/nchs

ISSN 1941–4927 (Print ed.)

ISSN 1941–4935 (Online ed.)

DHHS Publication No. (PHS) 2012–1209

CS232926