Availability of Electronic Health Records Among California Physicians and Advanced Practice Nurses

Electronic health records (EHRs) are an important tool for managing information about patients and improving outcomes and processes of care. In 2009, President Obama signed the federal Health Information Technology for Economic and Clinical Health (HITECH) Act. The act provided $27 billion for Medicare and Medicaid (called Medi-Cal in California) incentive payments to hospitals and certain health professionals who adopt EHRs certified by the federal government and use them to improve patient care.

• In 2011, researchers affiliated with Healthforce conducted surveys of physicians and advance practice nurses (nurse practitioners and nurse midwives) in California regarding the availability of EHRs in their practices prior to the implementation of Medicare and Medicaid EHR incentive payments. Major findings included the following:
• Most physicians (71%) and advanced practice nurses (78%) in California had some sort of EHR in their practices in 2011, but less than half had EHRs with the advanced functions necessary to achieve “meaningful use” as defined by the federal government (e.g., order prescriptions, view test results, communicate with patients electronically).
• Practice size was the strongest predictor of EHR availability.

Physicians and advanced practice nurses in large practices were more likely to have either a basic or an advanced EHR than physicians and advanced practice nurses in small practices. Physicians and advanced practice nurses in practices with a high percentage of Medi-Cal patients were less likely to have an EHR.
These findings suggest that implementation of Medicaid and Medicare incentive payments may attenuate these differences because they provide small practice and high volume Medicaid practices with additional financial resources that may make it easier for them to invest in EHRs.