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Just under one in four community physicians are using electronic health records; fewer than one in 10 are using EHRs that perform at least four functions deemed critical by the Institute of Medicine. That’s according to a new study specially commissioned to provide a reliable baseline to assess future IT adoption.

Although many surveys on EHR adoption have been conducted, estimates vary widely. That’s because the surveys use different ways of defining both what an EHR is and what constitutes use of an EHR. Some surveys, for example, may simply count whether electronic tools were available to physicians. Others assess how frequently or thoroughly physicians use these systems.

Instead of conducting a new survey, the researchers critically examined surveys on EHR use taken between 1995 and 2005. They selected out surveys that addressed EHR use adequately and met predefined quality criteria. These criteria included large, representative samples, high response rates and precise definitions of EHR.

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The selected surveys all estimated EHR use between 17 and 25 percent. However, the study singled out one particular survey, the National Ambulatory Medical Care Survey, as particularly reliable. This is an annual, government-funded, nationally representative survey of all ambulatory visits to physicians whose practices are not hospital-based. It puts EHR use at 23.9 percent, but said only 9 percent of EHRs incorporated at least four of the functions recognized as key.

“Despite the potential importance of EHRs, there is a surprising lack of consensus about just how prevalent—or, more accurately, just how rare—they are in the current health care system,” said Ashish Jha, assistant professor of the Harvard School of Public Health and lead author on the study. Other researchers were from the Institute of Health Policy, Harvard and George Washington University.

Still, the researchers said there is a growing consensus that an EHR system should be able to electronically store patient notes, display laboratory and radiology results, and transmit prescriptions.

The vague definition of what an EHR does has stymied programs to reward physicians for adopting the systems. Though the study, published Oct. 11 in the journal “Health Affairs,” did not mention it, the Certification Commission for Healthcare Information Technology, a nonprofit group representing payers, providers and IT vendors, has published criteria for ambulatory EHR and certified a number of vendors. Though smaller vendors protest that the certification program is too expensive, the Health and Human Services secretary praises the efforts.

None of the surveys conducted on hospital-based physicians were deemed to have enough reliable information on EHR use to form a definitive estimate. That’s because many surveys focused on just one function of an HER—ordering prescriptions electronically. Only about one in 20 hospitals use computerized order entry systems.

None of the nationally representative surveys directly assessed whether facilities that serve minority and disadvantaged patients were less likely to use EHRs.

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