According to a new study from researchers at the University of California at San Francisco (UCSF), EHRs are widely used by California physicians, but many of their systems are not designed to meet meaningful use standards. The research report says while 71 percent of California physicians have an EHR system, only 30 percent have one with the functionalities needed to achieve meaningful use requirements from the Centers for Medicare and Medicaid Services' (CMS).

An example of this is the lacking ability to communicate electronically with other healthcare providers, such as pharmacies, labs, other clinicians, and hospitals, to whom physicians refer patients. Medicare payments to physicians will be reduced in 2015 if they do not meet these requirements. The report’s authors, in collaboration with the California Medical Board, for the California HealthCare Foundation and the California Department of Health Care Service, conducted a survey to draw these conclusions.

The survey used 7,931 California physicians in the sample who reported that they practiced in California and provided at least one hour of patient care per week; 5,384 of these physicians (68 percent) completed the survey.

 “We found that physicians are more likely to have electronic health records with functions that support individual patient visits rather than functions that support overall quality improvement,” lead author Janet M. Coffman, PhD, assistant professor at the UCSF Philip R. Lee Institute for Health Policy Studies and UCSF Department of Family and Community Medicine, said in a statement.

As an example, 61 percent of physicians have EHRs that enable them to record clinical notes electronically but only 45 percent have the capacity to generate routine reports of quality indicators, such as the percentage of patients with diabetes who receive recommended lab tests, foot exams, and eye exams. The size of a practice was the largest indicator of whether or not they had an EHR. Physicians who practice in Kaiser Permanente, other large medical groups, the Department of Veteran Affairs, or the military are much more likely to have EHRs than physicians in smaller practices.

In the area of Medicare and Medicaid incentives, Coffman said the researchers found they are  especially important to community health centers, rural health clinics, and other practices that primarily serve Medicaid beneficiaries and uninsured persons are less likely to have EHRs. “Many of these practices are struggling to keep their doors open. Medicaid incentive payments give these practices an opportunity to purchase EHRs,” she said.

She said in terms of improvements, systems can do be better in alerting physicians and other health professionals when patients are due for screening tests, and electronic prescribing systems can incorporate alerts to warn providers if they attempt to prescribe a non-standard dose of a medication or a medication to which a patient is allergic.