"EHR is probably the most important element in developing the future of medicine. Much can be leveraged from the appropriate acquisition of clinical data in a queryable database." — Cardiologist, CT

Over the last few years, the percentage of practices using electronic health records (EHRs) and the number of cardiologists participating in the federal EHR Incentive Program has grown tremendously. With these developments, clinicians are recognizing some real benefits from their EHRs, however, according to the May CardioSurve survey, much room for improvement still exists for this technology particularly in the areas of interoperability and closing gaps in treatment and care.

EHR Activities and FunctionsNearly eight out of 10 cardiologists (78%) indicated they have been using EHRs for at least two years or more. More importantly, nine out of 10 cardiologists said they have a fully functioning EHR program or are in the process of implementing one. Popular CV practice EHRs continue to be Epic, Allscripts, NextGen, Cerner, GE Centricity, e-Clinical Works, Athena Clinicals, GEMMS, and Greenway.

Given this increase in usage, as well as opportunities through 2015 to receive financial incentives, it’s not surprising that nearly 80% of respondents also said they are participating in the EHR Incentive Program – up from 58% in 2011. The threat of looming financial penalties is also an impetus for adoption. Physicians and hospitals that had not implemented EHRs and did not participate in the EHR Incentive Program in 2013 had until July 1 to begin participating in order to avoid a penalty in 2015.

This uptake in EHR adoption has also resulted in several tangible improvements in patient safety, quality care and medication adherence. Nearly all cardiologists said their EHRs allowed for patient/clinical notes (95%), ordering of prescriptions (93%) and electronic tracking of patient medications (92%). In addition, 76% of those surveyed indicated their EHRs are capable of importing lab results with 50% able to import imaging results. Because of these features, clinicians noted that EHRs have had the greatest impact on timely access to medical records (86%) and prescription refills (84%), followed by helping to avoid medication errors (60%) and assisting in communication with providers (57%).

However, respondents also highlighted several major areas for improvement. Only a little more than 1 out of 3 cardiologists (35%) indicated they were extremely/very satisfied with their EHR systems overall. While reliability (40%) and sharing of medical information (37%) received the highest satisfaction scores, these results were outweighed by dissatisfaction with interoperability with other software (51%) and integration with medical devices (55%). EHRs also have fallen short in impacting the delivery of care - either meeting guidelines for preventive (36%) or chronic illness (32%), enhanced communication with patients (38%), and improved quality of clinical decisions (28%).

EHR Satisfaction – Overall and Specific Elements"In my opinion, all EHR systems need to have a standard platform otherwise it makes it very difficult for providers that may practice in multiple systems over time," said one clinician. Another noted that EHRs "are very helpful, but all the demands detract from physician-patient interaction."

Moving forward, the survey data suggest there is still a large amount of work to be done if EHRs are to play a true role in improving delivery of care – either preventive or chronic illness. Finding ways to help physicians meet guideline-recommended care and improve communication with patients should be key areas of focus. EHR features that allow for easy import of hospital data feeds, include reminders for guideline-based interventions and/or screening tests, and track patient medication adherence were less common among survey respondents and could also be a good place to start.

"The mandating of EHR has impaired physician practice in a way that nothing before it hasdone. Job satisfaction, patient satisfaction, professionalism have all suffered." — Cardiologist, TX

As the ACC moves forward with implementing its Strategic Plan, partnering with EHR vendors and other health IT stakeholders to make EHR use more streamlined, interoperable and conducive to improving patient outcomes and care is a leading priority. The College intends to use the survey results to inform these actions.

For more information about EHRs, as well as the EHR Incentive Program, visit ACC.org/HealthIT.